Sunday, April 10, 2011

My Big Fat Social Stigma

Obesity is everywhere. Articles, news segments, conversations abound about childhood obesity, fat as an epidemic, a public health problem that weighs on our health care system and national economy. At the same time, the more we talk about it, rant about it, focus our energy on preventing it, curing it, fixing it, the more we reinforce social stigmas surrounding body size. In fact, the stigma is so strong that it's fueled some of the fire against the war on obesity. Oddly, as this country's fat-phobia continues to grow so do the population's waistlines. So while the percentage of overweight or obese children and adults has increased, so has the weight bias against them. Somehow our efforts to encourage healthy weight and behavior have been perverted into shame campaign targeting large sectors of the population. If you're not convinced just watch these anti-childhood obesity PSAs (note: I considered embedding one of the videos, but they're too awful to promote). And, we are seeing further global spread of this stigma, as America has exported its unattainable cultural ideal of thinness and its fear and disdain of fat to countries worldwide.

While cleaning and sorting through my stuff this weekend I was watching Hulu, which was promoting a Lifetime movie called To Be Fat Like Me. And, while I'm slightly embarrassed to admit it, I watched it. With this issue of fat stigma on my brain for the past few weeks, I was secretly hoping that Lifetime had tackled this issue, neatly tied it up in a two hour made-for-television movie that I could point others toward and say, here: this is what I'm talking about.

No such luck. The movie reveals the constant bullying, discrimination and somehow publicly acceptable slurs that people of size endure regularly. At first Aly, the protagonist, a high school jock and popular pretty girl is shocked to learn how she is treated when wearing the fat suit and going undercover as a fat girl. But when she gets upset and feels low, she can still take off her fat suit and live her thin life. The scenes are interrupted for commercial breaks with ads for weight loss cereals and products and at the end of the movie Aly's message undermines everything she has learned about the challenges facing overweight individuals. She still criticizes her diabetic mother for everything she eats, she diets because she is concerned by the weight she gained from a sports injury that has prevented her from training, and in the end goes back to her hot boyfriend who admits to her that he probably wouldn't be attracted to her if she were heavy. In the final scene, Aly talks straight into the camera and morphs from her larger self to her thin one, encouraging people who are overweight (her audience is presumably teenage girls), saying that they are the ones who must sum up the courage to find their inner identity. Armed with a healthy sense of self, she seems to be saying, no one can make you feel small.

To me, the film's mixed message supported the work of Linda Bacon and the Health at Every Size movement, which aims to teach people that a healthy diet and lifestyle may not pave the road to thinness for every single person. But being thin does not equal being healthy or being happy. One of my favorite passages from Geneen Roth's Women Food and God was about just this:

"We don’t want to be thin because thinness is inherently life-affirming or lovable or healthy…We want to be thin because thinness is the purported currency of happiness and peace and contentment in our time. And although that currency is a lie – the tabloids are filled with miserable skinny celebrities – most systems of weight loss fail because they don’t live up to their promise: weight loss does not make people happy. Or peaceful. Or content. Being thin does not address the emptiness that has no shape or weight or name. Even a wildly successful diet is a colossal failure because inside the new body is the same sinking heart. Spiritual hunger can never be solved on the physical level."

Roth's approach deviates from Bacon's in that she sees weight issues stemming from underlying emotional and spiritual issues, and for many that may be the case. Her argument loses strength when she claims that once you address the root of eating that pounds come off and disappear, because that is not always true. People are also programmed differently, have different metabolic needs and ideal body weight can be very difficult to assess. Right now our society does not leave much room for individual difference and as we export our thin ideals around the world we reduce cultural difference as well. At a time when we're so concerned the recent release of radiation into our oceans and environment, we fail to think about the toxic ideas, values and stigmas we constantly spread by word, by page and by action. Why aren't we more concerned about preventing, reducing, reversing the spread of toxins that are in our control?

Friday, April 1, 2011

Women, Food and Good Company

The past few weeks have not been lacking for inspiration but I have resisted the urge to blog for fear that the real overwhelming issue on my mind would seep in and take over any attempt for a cohesive discussion of anything else. The looming question: (where) will I get a dietetic internship?

The dietetic internship is not something I fully understood when I entered the field of nutrition. It is a requirement of the American Dietetic Association that after completing the bachelors or masters level coursework in dietetics, students spend 1200 hours in supervised practice before they can sit for the exam to become a registered dietitian (RD). While it certainly makes sense for students to be exposed to clinical nutrition settings before entering the field, the dwindling number of internship positions and growing number of people entering the field of dietetics has led to the supply and demand imbalance:
More than 50% of applicants will not find placement for an internship, which is conducted via computer matching, and candidates can re-enter the pool for up to five years. This only increases the applicant pool every subsequent year (as evidenced above) and floods the market with nutrition degrees who are prevented from practicing and serving in the field. At a time when public health outcries call for nutrition education and more emphasis on food and diet, the ADA's internship system is a disservice to its cause.

Some universities have coordinated programs in dietetics, which means that admission to their program ensures your placement in their dietetic internship. I now see the repercussion of attending a school that does not have a coordinated program and in retrospect such a decision is difficult to justify. Internships are unpaid, with a handful providing modest stipends. Most, instead, have hefty price tags, with some tuition exceeding the cost of a year's graduate tuition. I was horrified to learn that they offer no financial aid or living expenses money. When I first met with my advisor a year ago she jokingly asked if I had a rich husband. I later learned that she wasn't really joking.

Beyond the financial pressure is the psychological stress. Having spent over six months now agonizing over the internship, the sheer weight of that pressure casting a shadow over my entire year, I can't help but wish I were guaranteed a position next year, in the same city where I studied, where I want to live, where I have a social network and a strong committed relationship. Instead, I wonder if and where I might end up next year. Which coast will I be on, if any? Will I start my internship in June, July or September? If I don't get an internship should I start looking for a job? The uncertainty was reassuring at first. It's out of my hands. I did my part and now I just wait. But the waiting slowly dissolved into the torturous "what-if" downward spiral of thought.

After working hard throughout the winter to perfect personal statements, complete applications, nail interviews while simultaneously satisfying the demands of a rigorous course load, part-time work and volunteer schedule, I was looking forward to spring break. But with no plans to leave the rain-slogged Northwest it was hard to unwind and relax, despite more free time on my hands. In fact, this simply gave me meant more time to wonder what the future holds. I tried yoga. When the rain let up I went for runs. I watched movies and television, read books and magazines. My mind kept coming back to the same thing. Then I left town. Everything changed. Just a few hours south in the crunchy northwestern parts of Oregon I spent time with friends, ate good food and forgot my fears. I rode my bike around Portland and counted the number of birds I saw adorning pretty much everything (okay I didn't count but should have!). I left my laptop at home and rode around in the rain. I spent hours in the car listening to old mix tapes. I sat around with smart, funny women, reading tarot cards, playing games and laughing at the absurdity of the internship process. Discussing fad diets and nutrition issues. Remembering all the reasons I do love this field that I rededicated my life toward three years ago.

Food is about communion and being with people and sharing, nourishing, giving life. A few weeks ago I'd read Geneen Roth's Women, Food and God. I like my friend Ginger's review of it, and like her I found its underlying message was positive. Overall, though, the book was lacking. God was lacking. The author's credentials seemed to be lacking. But mostly the "women" were lacking. Peppered with anecdotes from some of the women Roth has encountered through her retreats and classes, the book doesn't provide the reader with a sense for these women in all their glory. They are abused, looking for love, depressed and masking their emotions with food and detrimental eating patterns. They seemed deflated, one-dimensional case studies, cautionary tales to glean lessons from. Over the last week though I've learned that there is no substitute for spending time with real, strong women, honest about their shortcomings, regrets, fears, hopes and dreams. Returning home I am not so much afraid for the internship announcement on Sunday as I am excited. Excited to start planning for life after June, to jump the next hurdle, to be one step closer toward practicing my profession, to put this application experience behind me and embrace the next.