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S1 E 12 Weight-Centric Care - Where we've gone wrong with Adrien Paczosa
78 Plays2 years ago
Why might pulling back from a weight-centric model of care be in our best favor as a society? What do other approaches look like and what are their limitations?
Listen in as Adrien, Registered Dietitian and founder of Nourish, and I go into the challenges we face with practitioners, peers, and resources as the over-arching goal of improving health and relationship with food and body continue to be a struggle in this society. We dig into what health at every size and body positivity are, what a better relationship with your body can look like, and dive into the very important nuance of health that is so often overlooked.
Adrien Paczosa (RD, LD, CEDS-S) has more than 20 years of experience working in the dietetic field with a focus on eating disorders, neurochemistry nutrition, and business development. In 2007, Paczosa founded and opened her first private practice in Austin, Texas called iLiveWell Nutrition. Paczosa combined evidence-based nutrition science with a compassionate approach to counseling patients to deliver health outcomes and improve patients’ day-to-day lives. She has personally counseled with hundreds of patients ranging from severe eating disorder cases to diabetics to high-performance athletes.
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Please note nothing you hear on this podcast should be taken as medical advice. Always consult your physician before taking action.
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Transcript
Introduction and Guest Welcome
00:00:00
Speaker
Welcome back to the eating between the lines podcast. Today, my guest Adrian Paxosa, founder of Nourish, and I go into discussion around why pulling back from a weight centric model of care is in our best interest as a society. I want to take note, we talk a little about practitioners, doctors specifically around their nutrition education. And I just want to highlight,
00:00:30
Speaker
that not all practitioners are created equal. And there are many, many that do a wonderful job around nutrition and how they help patients. So just want to take note of that. I'm really excited about this conversation. Let me know what you think.
Untangling Diet Culture
00:00:49
Speaker
Hello and welcome to eating between the lines.
00:00:53
Speaker
I am your host, Therese Martinez, and I am so happy to have you here. If you want to untangle yourself from diet culture conditioning and get appropriate, actionable options to nourish your unique life and body, I'm going to dive deep into the nuanced spectrum of health to help you figure out what to prioritize in your journey
00:01:13
Speaker
without getting trapped in the extreme ideology of health optimization or total complacency. I am here to help you apply the science effectively, not rigidly, and get you feeling better in your body and mind. Here is how to eat between the lines.
00:01:35
Speaker
Hello, hello, welcome back everyone.
Adrian's Journey in Nutrition
00:01:39
Speaker
Oh man, I am so excited to introduce to y'all today's guest. This is Adrienne Paxosa. She has more than 20 years of experience working in the dietetic field with a focus on eating disorders, neurochemistry, nutrition, and business development.
00:02:00
Speaker
In 2007, Paxosa founded and opened her first private practice in Austin, Texas called I Live Well Nutrition. She's combined evidence-based nutrition science with a compassionate approach to counseling patients to deliver health outcomes and improve patients' day-to-day lives. She's personally canceled with hundreds of patients ranging from severe eating disorder cases to diabetics to high-performance athletes.
00:02:24
Speaker
A few years later, I Live Well Nutrition has become Nourish, a nationwide virtual first nutrition group focused on addressing America's healthcare crisis through greater access to nutrition care.
Health at Every Size Perspective
00:02:37
Speaker
Paxosa now serves as the chief clinical officer of Nourish and what started out as just an idea now serves thousands of patients, nearly all of whom use the service via telehealth and are completely covered by their health insurance.
00:02:53
Speaker
Welcome, Adrian. How are you? I'm fabulous. I'm so excited to be here. Yes, I am so excited to have you. For those of you that don't know, I actually started working for Nourish in January, and this is what stimulated a huge interest to have Adrian on.
00:03:14
Speaker
I have historically practiced a lot in the non weight centric realm, non diet realm, and honestly, since working for Nourish, I have been recently more inspired to dig into this even more. Nourish really practices from a health at every size angle,
00:03:36
Speaker
And it has just been so inspiring to actually see a lot of the research and science around this and to honestly kind of understand my own biases and stigmas and all of that when it comes to weight and weight-centric care and such. So excited to dig into this, Adrienne. I just have been really looking forward to it.
00:04:02
Speaker
Yeah, I'm excited here. I'm excited that being a part of Nourish has sparked your deep dive into it even more. That makes my heart real happy. Oh, gosh, yes. I think so much of it, too. Looking at the growth of Nourish is just mind-boggling. But in addition to that, seeing all of these extremely brilliant RDs
00:04:26
Speaker
that are not taking this weight-centric angle is really inspiring to me and also kind of keeps me hopeful for the future too. I think largely because of
00:04:40
Speaker
Well, honestly, the education that we have gotten as registered dietitians, there is often such a weight-centric approach. Do you agree with that? Is that kind of your personal experience?
Adrian's Educational Background
00:04:53
Speaker
Yeah. Yes. And I'm a little old. When I went to school, it was
00:05:02
Speaker
a while ago, I'll just put it that. And very fortunate my school was very much more sciencey, nerdy, biochemistry driven. And it wasn't, we talked about weight, but it wasn't the root cause. It was more like, can we understand the mechanism of this disease? And how is it biochemically showing up in the body? And what is nutrition's implications?
00:05:27
Speaker
I don't even really remember, but that was 20 something, 20, 30 years ago, a lot of the courses, but I don't remember it being super BMI heavy or anything else like that. So from my perspective and my personal experience, no, but what I've seen as far as interns coming through the practice, through everything, I have seen a shift into more weight-centric.
00:05:56
Speaker
But with a wonderful breath of fresh air, I think a lot of dietitians fall somewhere in the middle. They've had all this education. They're like, I don't really understand why it has to be focused on weight, but I don't know what to do with it. So I think a lot of dietitians fall in the middle and they don't know what to do.
Founding a Practice Focused on Eating Disorders
00:06:16
Speaker
Yes, yes, yes. I would definitely
00:06:21
Speaker
kind of consider myself one of those over the course of the many years and then kind of recognizing and evolving in the past few for sure. But it's a challenge, I imagine, like just a challenge too. And then resources, I feel like that's so hard too. Who do you trust? And navigating the bombardment that is the media and telling all the shoulds and shouldn'ts and fear-bongering, it's tough, even as the professional, right? And I think that's the,
00:06:48
Speaker
Can you imagine what everybody else is doing, you know, as ones that are not a little bit more well versed in, in a lot of this. And so, okay. So talk to me a little bit about the progression of I live well and kind of the people that you worked with there and your own involvement with the health at every size movement. I kind of, I definitely want to get into more details around what that is, but let's just start with a little bit more of your background.
00:07:17
Speaker
Sure. So, started I Live Well just out of one passion, but also just kind of necessity. What truly fuels my heart is creating access to dietitians, like anything I've ever done professionally, like, okay,
00:07:34
Speaker
How is this going to help people get to dietitians? Because I have the idea that dietitians will fix anything. And so was very, have always been very active in the Academy and our local dietetic chapters and was working at a hospital and working. I was actually working at a gym and somebody raised their hand and like, oh, we have a local eating disorder treatment center that needs help. Can anybody help out in
00:08:02
Speaker
I raised my hand, I'm like, should I help out? I don't know anything about eating disorders. Why not? And walked in and I was like, oh, holy bananas. I need help. I have no idea what I'm doing. And I love it. Um, so like immediately called up, uh, Jessica Setnick, who, uh, is like the mother of eating disorders. I was like, help, what do I do? Um,
00:08:25
Speaker
and slowly figured it out and then noticed that there was no outpatient dietitians in the area that for what when somebody would leave treatment I was like oh that's silly why doesn't somebody do that and to me at the time it was really important to accept insurance because
00:08:42
Speaker
One, I was like, I can't afford myself if I needed to see a dietician every single week. So that's bananas. And then two, I wanted dieticians to be a part of that medical community. And so I was like, okay, I'm going to figure this out. This is super important. I made a lot of mistakes. This is before there was Facebook communities and business coaches for dieticians. It was all paper. It was wonderful. So I made lots of mistakes. I got paid pennies a couple of times.
00:09:11
Speaker
But really wanted to make sure that that was a key part of building a practice. And slowly started to see patients, see patients, see patients. And then we got a phone call overnight from our local grocery store in the central Texas area saying, oh, we see that you're a dietitian on this health insurance plan. And we have a program for our employees that if they're diagnosed with diabetes, we'd love them to see a dietitian
00:09:41
Speaker
once a month for the next six months, would you be able to take on some patients?" I was like, oh, of course, happy to. They're like, great. We're going to be sending you 60 patients a week. I was like, oh crap. So that's where kind of evolved into needing to hire other dietitians.
Prioritizing Emotional and Physical Health
00:10:00
Speaker
And so kind of like in the involvement of, you know, how did we kind of go from, you know, just a typical dietitian into more of a hazelined weight neutral practice is we started in eating disorders and that's kind of where our roots are and really looking at a person as a whole.
00:10:22
Speaker
and accepting or respecting that there's inherent differences in diversity and body shapes and really rejecting that idea of weight. And was it a conscious one? I wish I could say it was, but honestly, it was more organic. Like it was one of those like, this person is really emotionally and physically struggling with their eating disorder. I don't care what a silly little scale says or their gravitational pull on this earth says,
00:10:51
Speaker
they're in pain, emotionally, physically, mentally. So how can I help them? And to me, that was the first and foremost priority. And same with diabetes, somebody is emotionally, physically in pain and kind of using air quotes in that. So how can I help them and how can we use nutrition to support? And so to me, it was not about a number on the scale, it was more of helping and supporting the top priority.
Changing Societal Narratives
00:11:21
Speaker
Yeah, yeah, that makes sense. And I'll just, it just makes me think like if we didn't have all of this bias behind us anyways, that would just be the organic way to approach it, right? Like it's like that, of course, that's what makes sense. So, oh man. Okay, so then rolling into that, like now it's evolved, you know, way beyond just eating disorders too.
00:11:49
Speaker
And there are a lot of folks that kind of come in with desires around weight loss and concerns around body size. I kind of want to just talk a little bit around
00:12:03
Speaker
The navigation with folks in with that centric appeal and this look in terms of why it's important to pull away from that focus. Like, why, why do we need to consider health at every size? Like what is the, what's the reasoning behind that? Yeah.
00:12:24
Speaker
I think it's normal. And I think that's the first and foremost thing. Is it normal for patients, for people, for humans living in the world who want to lose weight? That's the world we live in. And so that is a normal thing. And I don't think that'll ever change. I kind of always joke with our dieticians. I'm just like, everybody that ceases wants to lose weight. I would say like 95% of people want to lose weight.
00:12:49
Speaker
even some of our very, very sick eating disorder patients want to lose weight and they still want to lose weight. And so I think first and foremost, not to blame or shame or say that's a bad thing, like that's the society we live in. And so just kind of accepting like, got it, awesome. And as opposed to like saying you can't lose weight, that's not what it's about. And help at every size isn't about weight loss. It's not saying you can't lose weight, it's about
00:13:17
Speaker
How do we respect the body? How do we make sure that we're really being honest and truthful about health? And so I think that's where I really like to talk to people and meeting our patients where they are, meeting them of like, I get it.
00:13:30
Speaker
Definitely. I understand this desire to lose weight and we have so many other puzzle pieces that are out of whack that we can't lose weight or we can't even have those conversations because maybe your hormones are out of whack. Maybe our metabolism is out of whack. You haven't touched a vegetable in 30 years
Redefining Health Beyond Weight
00:13:47
Speaker
or you're so stressed or you hate who you are. Like there's so many other puzzle pieces that changing your gravitational pull on this earth won't matter.
00:13:57
Speaker
So let's fix those puzzle pieces and we'll see what happens. Yeah. Yeah, totally. I find it so challenging, you know, to kind of switch that, that narrative just based off of the, really the bombardment, right? So like, uh, I kind of, uh, when I'm working with, with patients, I often like first session kind of talk about.
00:14:20
Speaker
the psychological and physiological wiring of our bodies based off of our whole life and kind of this process of diving into both to see why we have landed the way that we have in terms of our relationship with food and like knowledge base, even seeds planted and watered based off of diets and parents and peers and all of that.
00:14:45
Speaker
And everybody comes in with like a different amount of untangling and rewiring that is needed. And it's also, gosh, sometimes it does feel like such an uphill battle to kind of pull away from that focus. For example, even for folks in like, see this a lot with folks, uh, postmenopausal where bodies, when bodies just kind of change and there is no caloric
00:15:14
Speaker
deficit that can, you know, remedy the situation. Do you have any like tips and input for folks when they are working on body acceptance without like feeling like they are being complacent with an unhealthy lifestyle? Like maybe we can talk a little bit about the correlations of that even. I would say first go to therapy.
00:15:41
Speaker
It's not the food, I promise. And I think that's a really great place to start is, for food, plus it's a little hard, it gets blamed for everything, good, bad, right, wrong. When food is amazing, it's not the food's fault.
00:15:57
Speaker
Um, and I think that's where our society and just diet culture continues to blame food. Like, Oh my gosh, carbs are bad. Fat is bad. So I, who knows what's bad today. I don't even know. Um, but something's always bad. And I think.
00:16:14
Speaker
As our bodies change because of life and aging and that's what it is supposed to do, it's so easy for us to want to blame ourselves, to blame food, to find something wrong as opposed to embracing
00:16:30
Speaker
and this instance, menopause and embracing this change. It's hard to embrace menopause when you're sweating and having those mood swings. But I think that would be an interesting cultural shift. And I know there's lots of different companies trying to shift that, but it's not the norm. Nora is helping every size, but I think
00:16:50
Speaker
One, I'd be curious to really help patients or everybody understand like food isn't our enemy. Like you are physically designed to eat food for it to digest, to turn into all these magical molecules that help you run. And so if we started to make peace with food, enjoy food and be honest with it, I think that would be a fun kind of experience for people to really play with.
00:17:18
Speaker
Yeah. Gosh, I just, I love that so much in the sense that like, just.
00:17:25
Speaker
pulling weight outside, like what you mentioned before, if we kind of isolate these variables, like if weight isn't so heavily correlated with health, what can we focus on just with our like foundational components of health and then just seeing where the body kind of naturally lands versus always digging into manipulate it and then saying, now I'm healthy. Right.
00:17:50
Speaker
Can you talk about any correlations with body size and health outcomes? Because there is research out there that has created these correlations. I'm curious what the research has shown that you've discovered, ways to combat that narrative also that you need to lose weight to be healthy,
00:18:14
Speaker
And that kind of thing, constantly seeing patients come in that are like every time they go to the doctor's office to fix anything, they just have to lose weight. It's like what they're told. So can you talk a little bit on that? Yeah. So I think correlation is a good thing for everybody to really understand. So.
00:18:34
Speaker
It's not a causation. So there will be scientific evidence that shows correlations to everything. Like if you brush your teeth at night, you are more at risk to have a heart attack. I'm making that up, but I have no idea. It's just that there's always ways for scientific evidence to show correlation. It does not mean that if you brush your teeth, you're going to have a heart attack at night. It's just took two sample data and put them next to each other and said,
00:19:02
Speaker
Is there anything similar between these two and random stuff pops up?
00:19:09
Speaker
There will always be shreds of science somewhere. And I think that's the hard part. And it's sexy to kind of publish this research and publish all of that. So if there was ever an unfavorable outcome or correlation, we would never find it. We would never see it because it's not sexy. It's not going to get published. But I think what we don't hear about is the huge dangers of weight stigma.
00:19:37
Speaker
and also the huge dangers of weight cycling. So when somebody has gained and lost a million and 12 pounds over all the different diets, it puts you at severe high risk for gallstones, muscle loss, tissue loss, chronic inflammation, hypertension, cancer, mortality. There's so many other issues with weight cycling that nobody ever talks about, as opposed to let's just take care of ourselves.
00:20:04
Speaker
And I think where I like to back up with patients in this is asking them, well, what do you define as health without weight? So if you didn't define your health, that's something on a scale, how would you define healthy to you? And that's where I want to start. And that's where I'm going to start to develop what that needs to be for somebody. I love that. I find it really interesting.
00:20:31
Speaker
the challenge that people have answering that question. Um, because I don't think, well, first a lot of patients don't know what they don't know. Right. And so it's like, in my mind, I could see this individual thriving with more energy and maybe like engaging in different activities and doing other, you know,
00:20:53
Speaker
Um, I don't know other like things with their family or just feeling better, right? Cognitive performance as well, but by like changing what they eat and then you never know or how they live or all the other, you know, confounded factors with health, but then like, um, you never know how improvement in those areas will transform someone's life. Right. So they don't know either. I've had people that come in or like, I didn't even.
00:21:19
Speaker
know that I needed more energy or wanted more energy. I just wanted weight loss.
Supporting Lifestyle Changes
00:21:24
Speaker
And so is there any like, and I know it's such a spine line as practitioners because we don't want to project our own like impressions of what is best for the individual. How would you like cue people to reflect on that? Like, is there a way to kind of dig in there?
00:21:42
Speaker
Yeah. Um, if people, if they're, if they're asking, well, I don't even know what that means or how to kind of like help them in that area. I would say, um, I mean, so if I would ask them, you know, well, how would you define health without using weight? I'm like, Oh, I don't even know. I'm like, well, would you be open to me sharing and some ideas? Um, yeah. And I say, this is a funny story. I like to use humor anytime I talk to people because
00:22:09
Speaker
Sometimes I feel really awkward and I don't know what else to do. And so I like to share, I was like, okay, so let me share this funny story. And this is actually a true story. So I watched one of my grandpas turn like, oh gosh, I think it's probably 95.
00:22:27
Speaker
live in his best life in the retirement center. He was too busy to come home and come to visit us for holidays because he had so many lady friends and had so many social activities and just was too busy. And I kept thinking to myself like, holy hell, that would be cool. I hope that I live that full of a life
00:22:50
Speaker
that I am just too busy with all of my friends, all of these wonderful encounters that I don't have time to like get on a plane. I'm like, that's what I want in my life. And so to me, that was a really interesting reflection point. And so I share that with patients. I'm just like, so maybe take some time. Maybe we don't have an answer today, but
00:23:13
Speaker
reflect on people around you, reflect on things that you desire, your bucket list, like what what it would fulfill your heart and soul to the nth degree.
00:23:26
Speaker
Yeah. And I just, I love that. And I honestly don't think that people really explore what that can mean for them enough, you know, um, what the possibilities are there. I mean, it's really easy to get stuck in the same energetic state day in and day out and lose sight of the potential that you can actually still accomplish.
00:23:56
Speaker
I feel like it's very common. I hear it all the time where it's like, well, I'm just getting old. So that's why nothing's working as well as it was. And that's why I don't have the energy or I'm creaking here and here. And it's like, yeah, to a degree, aging absolutely has an effect on a lot of systems in the body. And maybe it's not that like, you're not going to have the same type of energy when you were, you know, 18 years old.
00:24:20
Speaker
And perhaps you can still improve it perhaps you can still see what your body is capable of. And I just find that to be a challenge though for folks because of the
00:24:34
Speaker
I don't know, like how used to the way they feel they have gotten. And so it creates this challenge as a practitioner to stimulate reflection while also staying in my lane and being okay with whatever they choose for their life and their health, right? Yeah. Yeah. I think that that is a hard piece. And as you were talking about it, I was thinking of just like family members in everything and change is hard.
00:25:01
Speaker
It is really, really hard. And like, we got, we get all excited like, Oh my gosh, you're gonna have all this energy and ah, and they might be thinking, Oh, that's a lot of work. That's going to be a lot of work. Um, and so I think trying to figure out that balance of like, what's going to make sense to them and what's not going to make sense to them. And like you said, just being okay with what the journey they choose and
00:25:26
Speaker
i always say if it's two percent better holy guacamole yahoo we have two percent better than it is i think that is a huge win and so
00:25:36
Speaker
I also think having that reality talk with patients is like, I don't expect you to have like a complete 180 and at 75 years old being run in a marathon. No, I expect you to, you know, wake up, get out of bed and like, Oh, I feel pretty good today. Or, you know, I think looking for a 2% change is more realistic than 180. Yeah. Yeah. And.
00:26:01
Speaker
I think really painting the picture of what that process looks like, um, with the understanding that it looks different for everyone, but you know, a general like idea can be super helpful too. Um, just to kind of understand the feasibility and the process, the low hanging fruit steps that can be taken with the understanding that 2% looks like this. It looks like getting water in most, you know, like as much as you can every day.
00:26:28
Speaker
And then we build on it and then we build on, you know, and then seeing kind of how, how things evolve and adjust from there too. So, um, cause I agree. I think it just is very overwhelming to picture your life in a totally different fashion. Right. And so, yeah.
00:26:46
Speaker
I think a lot of patients get scared of that change. And here so many times patients are like, I just want it to be part of
Challenges in Medical Focus on Weight
00:26:54
Speaker
my life. I just want it to this to be easy. I don't want it to be a one more thing. And like me too. I can't wait.
00:27:01
Speaker
But we have to get to that, get through that phase before it turns into an automatic behavior. And I think that's the hard part for patients in general is that beginning part of anything change of just anything new, it's going to be bumpy and rocky and uncomfortable. And a lot of times our jobs as dieticians is just to walk alongside during that bumpy part. Yeah. Yeah, totally.
00:27:29
Speaker
Um, so we touched on this a little bit when, in regards to like the correlation versus causation, um, any, any input and thoughts around the challenges with weight and the doctor's office. And if this really was like such a correlation, why are doctors constantly focusing on it?
00:27:50
Speaker
Is there kind of validity to have like just physiologically having more weight on the body and what it does in like for a person in the body? And is it even worth examining, right? Cause there are so many other confounding variables of health that we definitely know. Is it even worth like getting nitty gritty into that or looking at the others? So I know that was a little bit multifaceted, but like maybe starting with the weight in doctor's office and research there.
00:28:19
Speaker
Yeah, so unfortunately getting weighed at the doctor's office will never go anywhere and having your BMI a part of your medical charts is never going to go anywhere because of insurance. It's a huge part of insurance and how they pay.
00:28:39
Speaker
Interesting. Okay. Yeah. And so sadly, that until our medical model of the world of the United States changes, that's where it's going to be. So yeah, reimbursement for insurance, Medicare, Medicaid is all focused around BMI a lot of times. So that's going to be a piece of it. So if you don't want to know, turn around.
00:29:07
Speaker
And if it bothers you, you can ask not to be weighed. Unfortunately, you will get a million and 10% pushback. So just turn around. It is just a thing. So I think that's the biggest thing. It's probably not going to change for a while. Yeah. What about with the doctors though? Cause I feel like a lot of patients come in and
00:29:29
Speaker
uh, that see me and have conditions that are almost always attributed to weight. And the recommendation is just to lose weight. That's why like, I see so many that get, that get prescribed these new, um, semi-glutides, you know, the Wagovi, Munjaro and all of these from the doctor, just because the fix is weight loss to them. And like for all of these conditions, like I cannot, there are patients that come in with like,
00:29:57
Speaker
Why are they talking about losing weight to fix this issue that really I don't understand?
Growth of Non-Weight-Centric Care
00:30:04
Speaker
But I think it's ultimately not understanding actual weight versus behavioral patterns that can sometimes be associated with weight. So why have doctors not gotten on board with this? I don't really understand that so much.
00:30:18
Speaker
So you and I both know that doctors get like an hour elective course in nutrition. And so sadly they don't have the education. There is a research article
00:30:34
Speaker
probably five, six years ago that said they, the researcher interviewed physicians and asked them like, do you feel like you were an expert in nutrition? And 95% of them said no. Then they asked, do you feel that you counsel around nutrition and weight loss? And 95% of them said yes. So they're counseling their experts.
00:30:56
Speaker
Um, and I think a lot of it is, um, plug for nourish is because they don't have a place to refer. And so they don't know what they don't know. Like our patients, they don't know what they don't know. A lot of times they're counseling from their own lived experiences, which is a whole other ball of wax. Um, and so I think that it's a huge.
00:31:19
Speaker
miseducation on the physician side, a lack of resources to dieticians. And so I truly believe doctors are trying to do the best they can for their patients. I don't think that anybody is being, I hope nobody is being malicious.
00:31:35
Speaker
but they only know how to treat with medications. A lot of physicians are evaluated and graded on the number of prescriptions they provide to a patient, so a lot of facilities or organizations encourage more medication management.
00:31:54
Speaker
Okay, that's honestly really helpful and very unfortunate. Yeah, I just need to go into every doctor. I think it just really goes to show like with the growth of nourish though, like the demand. I mean, since I've been working there in January, I mean, gosh, I actually don't really know the numbers of the dieticians that were there at that time. But
00:32:19
Speaker
It has just, the hiring has just been nonstop just because of the demand needed. I mean, it's huge. It's huge. It's huge. So hopefully more access continued and growth there will be so helpful.
00:32:34
Speaker
Okay. So how did every size, I want to talk a little bit about the, for lack of a better word, kind of the haters for that, like come at this in a little bit more of a judgy fashion and kind of largely with the misconception that they're like coming at a health at every size angle is a slippery slope to promoting unhealthy behaviors. Right. And so, or.
00:33:01
Speaker
It can also be partially one in the same with like the body positivity where people will be like, why are you promoting an overweight individual with the understanding that that equates to being unhealthy? So any thoughts with this? Like, how do you combat those people that, that judge the health at every size or even body positive movements that, that connect it with promoting unhealthy bodies and behavior?
00:33:30
Speaker
Yeah, there's gonna be haters for everything. So I think that's anything that's going to go against the curve is going to ruffle feathers, ruffle stuff, but what we're doing is ruffling people's biases.
00:33:47
Speaker
That's fine. That's fine. Not everybody has to agree on everything and that's okay. I think what's interesting to see is when somebody is like, oh, why help at every size? And you're able to show the research and you're able to show the outcomes long-term, you're able to show the dangers of weight cycling and really show it's about long-term behavior change.
Body Positivity and Health at Every Size
00:34:12
Speaker
then it becomes one of those, well, how could you argue against that? If we get rid of this exterior human suit and really focus on somebody's true biomarkers of health, like how is your blood pressure? If you have diabetes, if you have other conditions, like how are you doing mentally? We also forget about mental health.
00:34:34
Speaker
Yeah. So I think if we get rid of all of that exterior stuff, yeah. And as far as body positivity movement and just like health at every size, it swings on both sides. And I think there can be some toxic body positivity stuff. And I think that there can be some really positive stuff and it comes back to what resonates with you. It's going to take some time and discovery, but I think
00:35:00
Speaker
if somebody's on this journey, like, okay, I'm open to this, what do I need to learn? What's it all about? If it feels good to you, then it feels good and go for it. I think that's just, it's a very personal journey for a lot of people. Yeah, yeah, for sure. What would be, maybe even examples of like the toxic end of the body positive movement in your mind?
00:35:26
Speaker
Yeah, I think the toxic end and I think we've seen it with like kind of that toxic, toxic positivity where people feel like they have to be positive all the time. Body positivity and liking your body is
00:35:41
Speaker
Not going to be pretty every single day. You are a human. You live in a human suit. It changes day to day. You might love your body one day and be really upset with it the other day. And that's okay. Doesn't mean that you aren't being a body positive person. You are just living a human life and living the human experience. And so.
00:36:03
Speaker
To me, I think a lot of times people get wrapped up in being perfect and body positivity and perfect in everything in all of this. And you don't have to be there. It should be room for grace. There should be room for ups and downs. And so it's okay to have a bad day, to not like your body, to grow and be appreciative of your body. So it's, it's not linear.
00:36:28
Speaker
You know, I love that someone actually brought that up. We were talking about one of her patients that were struggling with like, self love, you know, and kind of that that idea of just body love. And she was bringing this up in the light that you just mentioned where it's like, just because you're healing your relationship with food and you working on your self love doesn't mean that you are
00:36:51
Speaker
and need to be okay with your body every day. It means that you're still going to nourish it, you're still going to work on treating it well, you know, but it doesn't mean that you have to like, love it every day. And I agree wholeheartedly that I think that's a misconception, honestly, even when folks are working back into away from diet culture,
00:37:12
Speaker
into intuitive eating and into more body love, self-love, where it's like, why do I still have desires to lose weight? Why can't I just love my body? Why can't I just be okay with the body that I have? And just get angry at themselves versus like,
00:37:32
Speaker
You know, it makes sense. It makes sense that I still want to lose weight. I mean, Lord knows the conditioning that I've had. And, you know, it also makes sense that maybe I felt more capable in a different body at one point, or there's an association that, you know, I have, or it also makes sense that I don't feel good. Maybe I started my period, whatever it is, right? And there can be a lot of different variables and you don't always have to have an explanation, right? All of those are explanations and you don't have to have that. It can just be what it is.
00:38:02
Speaker
And that's hard. Yes. Oh, as humans, we want to know like the why and we want to give it a reason. And so I think just going into all of this is just be kind to yourself and compassionate, which, oh my God, is a whole other ball of wax. But I think that's just the first puzzle piece of it is like, it's not going to be pretty. It's not going to be Instagram worthy, nor should it be. This is you and your journey.
00:38:31
Speaker
Yeah, absolutely, absolutely. It is, and I think it's helpful to also work on your inputs, right? So work on who you follow on the social media and honestly what you research
Embracing Body Positivity and Life Phases
00:38:44
Speaker
and read about and learn about to untangle that wiring that I was mentioning before and work on rewiring with more accurate information, which can look like seeing a dietician, it can look like seeing a therapist, it can look like,
00:38:59
Speaker
You know, reading, you're looking into your own research. I, um, I just got done reading Aubrey Gordon's, what we don't talk about when we talk about fat. Have you read that book? I haven't yet, but it's on my list. Oh my gosh. She's so great. I love her and the podcast maintenance phase just like so good, but I don't know. I just.
00:39:17
Speaker
reading that book and again practicing as a non-weight centric, non diet dietitian, I will just forever continue to learn about my wiring and what continues to be seeds that continue to be watered
00:39:31
Speaker
um throughout like this life you know um and how to combat it and i think combating a lot of the fat phobia and the weight stigma just requires input that that promotes the rewiring nature and that sheds light on other people's experiences too she has some
00:39:55
Speaker
really interesting and so, like, unfortunate experiences, just being in the body that she has been in for her life. And otherwise, she does a great job with research too. She's just so, so good. It's interesting, while you were saying all of that, I was thinking,
00:40:13
Speaker
Also patients forget we go through phases of life. So going back to your menopause patients, like they're in a different phase when they are going through menopause and when they might've been a mom, or if they didn't have that experience of mom in their twenties and thirties, then different experience. And so our bodies and our life changes and what we value and how we see ourselves and our body changes as we change and age and grow. And so I think,
00:40:41
Speaker
We're not supposed to look like we did or act like we did. Please don't act like you did in your 20s. I'm saying that to myself when I'm in my 40s, like there's different things. And so I think that isn't, I haven't, and I haven't seen it yet and it might be out there and I hope it is. I haven't seen that as part of this body positivity talk of like, where are you in your life?
00:41:03
Speaker
phase or your season of life. And that might also help and support where you are in your acceptance of your body. Yeah, yeah, absolutely. Absolutely. And I think again, just working to understand it can help some people that have that tendency to want to have some explanations. And while I'm saying the other side of the coin, sometimes you just can't explain it. So it's kind of a
00:41:33
Speaker
I don't know, but it's gonna be tough. So where do we kind of go from here in terms of like, we talked about this just a little bit just now, but what can people do to understand like fat phobia more, health at every size, you know, what can they do to take a stand in their doctor's office? Where do they go for help for kind of being seen in a different light and then also educating their own self
00:42:01
Speaker
around all of this. And I think also for folks that don't necessarily like struggle, I'm putting that in air quotes, folks that maybe, I don't know, would it be beneficial for everybody to kind of see their own biases? Because sometimes the ones that don't really see it are the ones that are the most toxic to me, right? And so,
00:42:26
Speaker
Is there an importance for that too? That's kind of a loaded question. I can break that down more if you need it. So yes, I think people wherever you are in this journey and especially if you're in the helping field, let's check your biases. We all have them and so know where you are and
00:42:45
Speaker
I cannot remember there's a place where you can check your weight biases, but there is a place. I'll have to find it and I'll send it to you. I was looking for it earlier. I was like, I see, I remember going. But it's aware you can kind of like do an online quiz and it like shows where weight biases are. So that's where I would say a good place to start.
00:43:09
Speaker
And then start to really do your own work. If you are in the helping field, if you are not in the helping field, if you're on this journey, it starts from within. And so just truly starting to be vulnerable and doing that internal work, meeting with a therapist, meeting with a dietitian and being open to it. I think that is where I always encourage people to start. And then,
00:43:37
Speaker
being kind. I think kind to yourself and kind to others. We're such in a judgment world. And once you notice your biases, I wonder if you don't need to
00:43:51
Speaker
voice all your kindness, if you want to, you can. But I think instead of judging people, what would it be like to offer kindness in your head of like, Oh, that person is magically like doing whatever that is opposed to judging them. And so I think offering other kindnesses to yourself and to others might be another place to start. Um, but I think really, uh,
00:44:17
Speaker
With a lot of dietitians I've worked with over the years, I say, check yourself before you wreck others. So doing your own work is so valuable. It makes a huge world of difference. And we're always learning. We're always learning. We're always growing. I don't think any of us have it ever all figured out, nor do the experts in this haze and body positive movement have it figured out either.
Promoting Nourish and Resources
00:44:43
Speaker
So I think it's just an ongoing process for us all.
00:44:47
Speaker
Yeah, totally. I love that. It just like triggered this other little thought for me too.
00:44:55
Speaker
when you are working on that judgmental component, which I think is probably the top tier of the toxic nature of all of this, right? Is kind of where the judgment originates. And that's usually, it's from us, right? And from conditioning, of course, too. But like, if we can stop the patterns, stop the thought patterns and like intervene at an appropriate time,
00:45:24
Speaker
we can then interject and stop the cycle from going further, right? So seeing, if they're seeing people and, and passing judgments, if it's on your own self and passing judgments, you know, stopping that cycle of thought that like goes just so far down and, or all the assumptions that come with, with it and really working on that, I think would also be
00:45:51
Speaker
just so game-changing because it starts with you, starts with you to like stop it. So, yeah. Well, Adrian, what a wonderful conversation. Where can people find more information about Nourish or anything else you want to throw people towards? Yeah, I would say definitely come and check out Nourish. So use Nourish.com and on all the social channels, use Nourish.
00:46:19
Speaker
It's just a bubbly full, a bubble full of great information and you get to meet with a dietitian.
00:46:26
Speaker
Yeah, I also have expanded a lot of their resources on the website. So even just checking out articles on there, you can kind of get an idea, loads of dieticians. You can see if your insurance is covered on there. The support crew is stellar if you have any questions. So absolutely, absolutely. Thank you so much again, and we will catch you guys next time.
00:46:55
Speaker
Thank you so much for listening today. If you found this information valuable, please share this episode and give it a review. They truly help a ton. If you want additional support and information, you can head over to my website, teresmartinezrd.com, where you can snag my free guide on how to improve your hunger signals, get on my email list for regular juicy content, or apply for the next round of my signature program, restoring nutrition intuition.
00:47:23
Speaker
Otherwise Instagram at Teresa Martinez RD or my Facebook group fed fit and fad free nutrition with Teresa are always places for more content and support until next time.