DRF ‑ IMPACT OF WEIGHT
	Wednesday, February 24, 2021
	7 ‑ 8:30 PM
	Remote CART Captioning

Communication Access Realtime Translation (CART) captioning is provided to facilitate communication accessibility.  CART captioning and this realtime file may not be a totally verbatim record of the proceedings. 
	>> Let's get started.  
>> Okay.  Just a second and I'll begin the recording.  
>> Here we go.  
>> Okay.  Good evening everyone.  I am so glad that you all were able to pardon me with us this evening.  My name is Annette Smith, I am currently the chairperson for the advisory council, and I will also be your moderator for this evening.  
So before we get started, we are going to do a little bit of housekeeping, and just to let everyone know that this presentation will be audio recorded.  So by joining, you are giving consent to be audio recorded.  And as far as the questions, we will be taking questions at the end of the presentation, but please feel free to type your questions in the chat box at any time during the presentation.  The questions will be taken at the end and at that time you will be able to raise your hand and ask a question or ask a question over the phone.  
I will explain those instructions when we get to the question and answer section.  So to go further, I'm going to go ahead and introduce our speaker for this evening.  Our speaker is Shira Collins.  Shira is a graduate student and clinical medical health counseling at Troy university in Tampa, Florida.  She is passionate about providing support to those struggling with disordered eating and body dissatisfaction, and building a world that values size and diversity.  Her work is informed by health at every size paradigm, fat lib ration, body trust, feminist s, and the disability justice movement.  She frequently presents on topics related to eating disorder treatment and prevention, as well as weight stigma and the health at every stage paradigm at conferences for mental health professionals, and peers.  She currently serves as the vice chair of the advise ry council to disability rights Florida, providing advice and support to a statewide organization on topics relating to mental health.  
So without further delay, we are going to allow Shira to come and present for us this evening on weight stigma.  
Shira?  
>> Hi.  Thank you so much for having me tonight.  And for the introduction.  I'm super excited to be here and to be talking about this topic.  
And I did just want to preface this presentation by saying that it is eating disorders awareness week.  And this topic is very connected with eating disorders, and I'll be sharing more about that.  That is kind of one of the reasons that I wanted to share more information about weight stigma and mental health.  
So to start off, I wanted to find weight stigma, which is defined as bias discrimination or stairio typing that is based on a person's weight or body size.  It's a highly prevalent form of prejudice, and it's rarely challenged.  So hence the need for more conversations about it.  
It's also referred sometimes as weight bias, size ism, fat phobia.  And before heading further into this topic, I do just want to share that I am a person with thin privilege, and as well as other privileges, too.  White privilege as well.  And that is definitely important to recognize when talking about this topic, and other topics.  
Next slide.  So I also wanted to share a note on language.  During this presentation, I won't be using the O words, listed on the slide.  I don't really like saying them out loud.  These terms are a stigma, and being a higher weight is inherently universally healthy.  They are medical terms used to describe certain weights.  So I will be using the language recommended by the national eating disorders association, also many, many eating disorder treatment provider s, and fat activists, which is people in larger bodies and higher weight people.  In addition, some activists have chosen to reclaim the word fat as a neutral descriptor, so that will also be included, just like we talk about tall and short people, thin people, blondes, we can also talk about fat and thin people and it can just be neutral.  It doesn't have to be a negative thing.  
So I will be including that word, and I just want to acknowledge that the intention is to neutralize that word not to include it as a negative descriptor or an  descriptor or an insult.  Here is some of the ways that weight stigma shows up.  If you have others that you would like to add, please feel free to do that in the chat.  Every day assumptions about individual's character, self discipline, eating, or exercise habits, and health status on the basis of body weight alone, basically we make this assumption that people in larger bodies must have less self discipline or be eating in certain ways or exercising or not exercising, in certain ways.  
And be unhealthy while we assume that thinner people are ‑‑ do have more self discipline and are eating in correct ways or healthier.  When that is not true.  And there is not as much of a correlation as we are led to believe.  
The thinness is another way that weight stigma shows up.  There is pervasive and constant promotion of weight loss in the media and in healthcare settings, just kind of constant messaging that the more weight we lose, the better, that we constantly need to be either losing weight or preventing our selves from gaining weight.  And this often comes with a cost of our health and well‑being that we are told basically to focus on that above everything else that contributes to our health or that makes life worth living.  
Hiring discrimination is another way this shows up.  That can include income disparities, workplace and school bullying, as well, discrimination, and adoption and custody.  That is also another way that weight stigma manifests that the BMI is sometimes a criterion used to exclude people from adoption which not many people know.  
Also, denial of healthcare due to body weight.  So often people in larger bodies when they seek healthcare for issues that are not at all related to weight, um, they are told just to lose weight and all of the health problems they have that may have absolutely nothing to do with body weight are attributed to their weight.  And there is just countless stories, if you look this up in the news and in the media about people who have had fatal diagnose sees missed because of their body weight.  Because everything is being attributed to their size and they are just told to lose weight rather than being tested for earn certain diagnoses or having certain things looked into.  
And I'll talk a little bit more in a bit about how this specifically affects mental healthcare.  But this definitely I'll say now applies to mental healthcare.  That often mental health diagnose sees are overlooked and people in larger bodies are just told everything can be solved if they just lose weight.  They will be happier and feel better mentally if they lose weight when that is often not true and causes more harm than good.  
Next slide.  So I just wanted to share some statics about how common weight stigma is.  At least 30 percent of higher weight girl and 20 percent of higher weight boys report being teased at school.  This starts at a really young age.  And they are not learning it from each other, they are learning it from the adults around them, one in three children has experienced weight bias from a teacher.  69 percent of higher weight women have experienced weight bias from a physician.  And higher weight women are paid 14.6 percent less than straight sized women.  Which straight sized is another term for small er bodied or average sized.  
So as you can see this is really quite prevalent.  Next slide.  I also wanted to share a little bit about diet culture, which goes hand in hand with weight stigma.  So diet culture is the promotion of eating and exercising and pursuit of fitness rather than according to one's internal cues and nutritional needs.  It involves the oversimplistic categorization of food as good or bad or healthy or unhealthy.  Which often leads to shame around eating and compensatory behaviors, and dieting is a very strong predict er of the development of eating disorders.  
Dieting is associated with a whole host of negative consequences, and I think 95 to 99 percent of diets fail.  Don't work permanently, in terms of leading to sustained weight loss.  So it really ends up doing a lot more harm than good.  And yet that is kind of constantly promoted because we value thinness so much over health.  
Next slide.  So here is some of the effects of weight stigma, and these all can be effects as well as dieting and diet culture.  Depression, anxiety, low self esteem.  Body dissatisfaction, suicidal ideation and attempts and disordered eating and eating disorders.  So often just the stress of being marginalized, facing that kind of discrimination, I mentioned that all really leads to serious mental health consequences.  
Next slide.  So I wanted to give some statistics about those and specifically eating disorders.  The best known environmental contributor is the socio cultural eyed dealization of thinness.  There are lots of things that do contribute to eating disorders, Jeanette ics, or trauma, generally can predispose people to eating disorders.  But the best known environmental contributor specifically is this eyed dealization of thinness, and as an eating disorder therapist in training, this is something I hear over and over again about experiences of weight stigma directly leading to disordered eating behaviors.  
40 to 60 percent of elementary school girls ages 6 to 1 are concerned about  ‑‑ 12 are concerned about their weight.  That is a young age for these  types of concerns to start and be a huge risk factor for eating disorders.  And 62.3 percent of teenage girls and 28.8 percent of teenage boys report trying to lose weight.  
So again, very, very young.  Next slide.  These are some more statistics on that.  Over one half of teenage girls and nearly one‑third of teenage boys engage in disordered eating behaviors.  And that includes skipping meals, fasting, smoking cigarettes for weight loss, vomiting and taking laxatives.  These are all again just the very young ages to be engaging in of some of these very risky behaviors.  13.2 percent of girls develop an eating disorder by age 20.  Among adolescent males, the prevalence of eating disorders is 1.2 percent at 14 years.  2.9 percent at 20 years.  And these may be underreported.  That is a possibility.  That often new research comes out and we see it's more common and that these are underreported due to sample size or due to stigma, and also as you can see here, there is not a lot of studies on like nonbinary people, or trans youth, and we do know those populations are at much higher risk of disordered eating.  That is all something that could kind of increase this prevalence as well.  
And one in eight adults have had suicidal thoughts due to negative body image.  So this is something that really seriously affects people's mental health.  
Next slide.  And I just wanted to give some more information on eating disorders, since that is kind of one of the most common or most well‑known effects of weight stigma on mental health.  Eating disorders are the second deadliest mental health condition, surpassed only by opioid use disorder.  People with eating disorders of all sizes, and I really want to highlight that, that we often think of eating disorders as occurring in only thin people.  Only people of a certain size, or of a certain race or a certain gender, um, when in reality, eating disorders affects people of all sizes, races, genders, cultural backgrounds.  They don't discriminate, but they are often missed, and people in larger bodies because of that stereotype and because we have this idea that if you are in a larger body, you must be eating excessively or you must not be exercising enough when the reality is that restrictive eating disorders occur in people of all sizes.  And that body size is not an indicator of how much someone is eating or how much they are restricting.  
So people with eating disorders of all sizes are at increased risk of a lot of different physical and neurological health complications, including heart failure, heart problems, kidney failure, GI problems, insomnia, memory loss and cognitive impairment s.  They often lead to increased depression and anxiety.  And even can induce paranoia and psychosis, just the starvation,  ‑‑ starvation over a long period of time affects the brain.  And they face an extremely high risk of suicide. 
I also wanted to talk a little bit about weight stigma, and marginalized identities.  Weight stigma impacts people in minority groups, including people of color, LGBTQ people, disabled people, women and trans people.  Weight stigma is rooted in racism and is used to justify these forms of oppression often.  
So often people of color and women are more affected by weight stigma, and weight stigma is kind of used to say that like if people in these groups are larger than that kind of justifies treating them more negatively.  There is a really great book that I highly recommend on specifically the topic of weight stigma and racism called fearing the black body by Sabrina Strings and it gives a great history of how the BMI has been used for like racist purposes.  And how the notion of obesity in quotes, has really been used to kind of marginalize people of color.  
And disordered eating is often underrecognized in minority groups.  People of color and LGBTQ people are less likely to receive treatment for eating disorders.  So that is something that is really important to recognize as well.  
Next slide.  So I really wanted to talk about in this conversation on weight stigma the social determinants of health.  We often have this idea that the biggest determinate of our health is what we eat is how much we exercise, and our weight.  And we also have this idea that those are linked, that how much we eat and how much we exercise is linked to our weight.  Which is not true.  And we also have this idea that both how we eat and how we exercise and our weight affects our health and are the biggest determinate of any health consequences that we are facing.  
But the reality is that social and economic factors like race, gender, income, disability, other types of factors have a much greater impact on health than individual behaviors.  So promoting weight loss as a solution to mental and physical health problems may come at the cost of addressing some of those issues.  
So often people of color and LGBTQ people, people in minority groups are told that when they are experiencing health issues, they are told that they need to lose weight.  That that will solve it.  Rather than looking at hey, maybe the issue here is that you are facing systemic oppression or facing an in equity that needs to be addressed, rather than telling someone to lose weight.  
Next slide.  So this is kind of a study that was done on what does affect health, and the percentage that each factor plays.  The percentage role.  That affects like quality of life, and health status, so as you can see, social and economic factors make up 40 percent of what determines health.  So that is a lot.  That is a big portion.  20 percent is clinical healthcare, 10 percent is physical environment factors.  And only 30 percent is health behaviors.  That includes not just like eating and exercise, but things like substance use, I believe that includes things like wearing a seatbelt, things like smoking, so when you really look at the big picture, eating and exercise really don't make up that much of our health, or don't influence it nearly as much as many, many other behaviors.  
And by the way this is excluding genetics, these are only modify able determinants of health, so genetics also of course plays a huge role.  Next slide.  
So this is a video made by the national eating disorders association by some fat activists and body liberation activists.  So I wanted to share that.  
>> I don't hear it either.  So stop sharing your screen, and share it again, but make sure to check to use the audio.  
>> Thank you.  Feel free to share any reflections on the video in the chat if you want.  But I think it does a really good job of showing both the way that weight stigma can impact mental health, and lead to disordered eating and how it intersects with other forms of oppression as well, but also how spaces where body liberation is a focus, and where people of all sizes are accepted and embraced, how that can be really healing and positive for people's mental health.  
Next slide.  So I wanted to talk a little bit about how weight stigma specifically shows up in mental health services.  So weight stigma is not, for some reason there is something that is blocking the PowerPoint.  I'm not sure.  Okay.  Thanks.  
Weight stigma is not commonly recognized as a contributor to mental health issues.  Often I think we tend to blame people kind of as individuals for their mental health issues, or we tell people you just need to get over it, or snap out of it.  Or we often look at it ‑‑ look at mental health issues as purely genetic, or purely biological, and we are not looking at the environmental factors that can contribute.  And weight stigma is a huge factor that does contribute.  So as clinicians, or peer providers, we are not asking people how his  has weight stigma impacted you.  Do you feel that it has played a role in any of the issues you are experiencing now.  And I think that could be really important.  That might be playing a big role in whatever issues someone is experiencing.  Eating disorders are underrecognized in individuals in larger bodies.  As I kind of mentioned, we have this stereotype of what eating disorders look like, and we believe that anyone who doesn't fit that stereotype must not have an eating disorder.  Substance use is often regularly asked about in like primary care visits or in mental health intakes for different services.  So is sometimes symptoms of depression or anxiety are asked about, but we are not asking about symptoms of eating disorders we are assuming that we can know whether someone has symptoms of an eating disorder based on their weight or size.  So it's really important to recognize that we can't know that.  That eating disorders don't have a look and that someone may be restricting their food intake regardless of what size body they are in.  
I also want to say, I've talked a little bit about restrictive eating disorders, binge eating disorder, too is an important eating disorder to recognize, and often what we find is that it results from restriction, that restriction is often the root of binge eating, and bingeing is the body's response sometimes to restriction.  And so that is kind of another way that eating disorders are sometimes missed or restriction is missed that we talk as a culture a lot about overeating, and bingeing, and bad foods that people are eating.  And not looking at restrictions.  
Clients in larger bodies are sometimes encouraged to diet or to lose weight instead of receiving quality mental healthcare, so, again, there is this idea that people's diet is causing their mental health problems, or their weight is causing their mental health problems, but if people lose weight, everything there be better, and they will be happier.  And that is really not often the case.  
And so that is often a reason that we kind of don't give quality mental healthcare.  Weight loss is sometimes praised as a sign of health or psychological improvement, without inquiry about possible disordered eating.  
Often if a client loses weight, it's just like, oh, good, I'm so glad.  Like that must be because they are making positive changes.  Without looking at could that be due to disordered eating, and if so, by kind of reinforcing them for that behavior is that reinforcing the eating disorder?  
Exercise, I wanted to just mention that, is very, very commonly prescribed in mental health settings.  As a way to improve mood.  And I think especially for people in larger bodies, there is this idea of like, oh, like, they need to exercise more, because that is a stereotype we have.  And there is not really a discussion of overexercise, or compulsive exercise or ways that exercise can become disordered.  Or exacerbate an eating disorder.  
That is already there.  Because exercise can definitely be part of disordered eating.  So that is something that we really need to discuss more, and include more, and kind of exercise more caution in prescribing that.  
Next slide.  So I also wanted to share this graphic, it's from the website science of eating disorders.  So I'll start with the one on the top left.  There is a lot of stereotypes about those who are affected by eating disorders.  As I said, usually the idea is that eating disorders only affect white, young, thin women.  Not anyone else.  And because those are so prevalent, that leads to clinicians failing to recognize eating disorders, and, quote, a typical populations, the reason that is in quote is eating disorders are much more common in people in larger bodies, in minority populations, people of color, LGBTQ people, all of those communities have disproportionate rating of eating disorders.  And yet we are still seeing that as atypical.  Clinicians often fail to recognize that, don't really ask about it.  Don't provide treatment, and often encourage people to further restrict, to lose weight, to diet, because that is what is seen as the healthy thing.  
And then those individuals are further alienated from seeking help.  Often if you are not recognized as having an eating disorder, you are not given help, then you are not going to continue to engage with the healthcare system.  
And because of that, because of that lack of engagement with the healthcare system, clinicians just continue to see individuals with eating disorders that do fit more of that stereotype, because that is the only people that are being recognized and seeking help for those disorders.  
So it kind of just leads to this vicious cycle where no one who doesn't fit the stereotype of what an eating disorder looks like is really getting recognized and getting help.  Which leads to further health disparities.  
So that is definitely something to think about, too, that often the health disparities that we might attribute to, quote, overweight or being at a higher weight actually may result from individuals being mis treated in the healthcare system, not being recognized as having certain health issues, including eating disorders.  And not getting the right help or people just in general being shamed in the healthcare system.  Having issues minimized.  And then just not engaging with healthcare services.  Which of course is going to lead to negative health outcomes, and dis parities, that that might not be directly attributable to being at a higher weight.  It might be more about how people are being treated.  
Next slide.  So I wanted to share one person's story.  This is a bit long, but I think it's just so important to be able to have the stories of people in larger bodies who have experienced disordered eating.  And what that has been like.  
So this one says, when I was 16 I started starving myself and lost a lot of weight.  I was never offered help.  I wasn't offered outpatient eating disorder therapy or evaluated for a higher level of care.  It was 1998.  I was a Christian teenager who came from a white working class family living in a middle class suburb.  At the time I did not have an understanding of eating disorders at all.  In fact, even if someone had educated me on what eating disorders were, I don't think I would even have thought that I was included in that definition.  And that in and of itself is part of the problem.  I had all the symptoms, but because I was fat it seemed impossible that I could be struggling with something socially defined as a disorder.  That seemed to exclusively affect small er people.  
Next slide.  In some ways, when I tell my story I feel that I have to express the deep intense pathologies that I experienced in order for people to believe me.  I barely ate.  I would lie about having a meal, so no one would question me.  I would flush food down the toilet to hide food and give the appearance that the food had been eaten.  I would track everything I ate while making sure it was not above the low calory count that I set for myself.  I exercised frequently.  I could not stop thinking about food.  I could feel my heart pounding in my abdomen when I laid in bed at night with an empty stomach.  Despite all of this, way  I was still perceived as fat according to medical standards.  After several months of this, I stopped being able to tolerate starching myself, and needed a way to copy with eating and my intense fear of weight gain.  I started making myself throw up using diet pills and laxatives.  Having to eat heightened my sense of feeling out of control, and posed a greater threat of gaining weight.  I spent hours pre occupied hiding what I was doing and I would lie if needed.  My pre occupation with food and potential weight gain didn't just have an impact on how I behaved around eating.  My entire life was affected by the obsession that I couldn't let go.  That was egged on by everything around me.  My grades plummeted.  I couldn't process information easily.  I was ashamed of my dishonesty, and fearful someone would confront me about lying.  I was almost the post er child for a lifetime movie on teen girls with eating disorders, except I was still fat.  And looking back I'm not sure that I was a girl.  So I couldn't possibly have had an eating disorder.  Right?  Despite the fact that I remained fat throughout my eating disorder, I did experience weight loss.  And when I lost weight from all the starching and purging, I was complimented.  Instead of being offered treatment, I received copious amounts of praise everywhere I went for losing weight.  And so I pressed on.  I tried harder.  I restricted more.  
Next slide.  Being congratulations is what happens when a larger bodied person loses weight.  It does not matter how they lost the weight.  It could be from an eating disorder, grief or serious illness like cancer.  This is why we should not ever comment on someone's weight loss.  We do not know the circumstances of why they lost weight.  If it happens to be that they lost weight intentionally, we only encourage disordered eating and body dissatisfaction.  That is exactly what happened to me.  And what happens to so many others like me.  And that is by Sarah J Thompson.  That is a link to their blog.  I highly recommend following them and their work.  And I'll have more resources to kind of follow at the end of this.  
Next slide.  So this is one more personal story.  It's a little bit shorter.  I grew up with a message that to be loved in my family, I needed to be thin.  Of course that message was confirmed further by our thin obsessed culture, and I spent the majority of my life fighting against my naturally larger body.  During my periods of anorexia, I saw how much better I was treated in my small er body and it made me more determined to fight for my life and stand up to the fat phobia I saw happening to people.  In my small er body I was praised for my weight loss even though I was dying.  No one made assumptions or judgments about my health.  I was able to find clothes at any store I walked into.  Living in my small er body felt so much safe er.  But that safety and relief came at the cost of everything else in my life.  As my body shrunk, so did my entire life.  I couldn't participate at holidays because I was afraid of being around food.  I turned down travel opportunities, because I was worried about not having access to the few foods I would allow my self to eat.  I isolated myself from all social events, because starving and exercising came before everything else.  My eating disorder took years away from me that I can never get back.  And that is by Sherry an eating disorder therapist.  She was also in the video that was shown earlier.  Another person that I highly recommend following her work.  
Next slide.  So this is one of the takeaways that I really hope is kind of one of the key points that you got from this presentation.  If you don't take away anything else.  I also really recommend following this blog, dances with fat.  The create er of this is Reagan Chastain.  You can follow her on social media.  She has a lot of great graphics like this.  You can tell looking at a fat person that they are fat.  That is it.  Not what they eat, not how much they exercise, definitely not if they have an eating disorder, and definitely not how smart they are.  You also might be able to tell if you have any prejudices or biases that are coming up, or if you are making any assumptions.  And that is a good thing to notice, and work on.  But from any of those assumptions that can come up for you or any of the prejudices that you have are true.  They are just kind of things that we have been told in stereotypes that we all have ingrained.  They are something to recognize and challenge when that happens.  
Next slide.  So here is just some more information about how you can start to combat weight stigma.  I think given that it's easing disorder awareness week, this is a really good time to be thinking about this issue, and to be thinking about ways that you might want to help prevent eating disorders and disordered eating by challenging weight stigma.  One of the first things to do is challenge any assumptions you have about people's character, eating or exercise habits, or health status on the basis of their size and just really recognize that you really can't tell someone's health status by looking at them.  Be willing to challenge any mis conceptions you have about what people with eating disorders look like.  I think one of the most hurtful things that is commonly said to people with eating disorders is you don't look like you have an eating disorder.  So really trying to notice like the impulse to say that or to think that someone does or doesn't look like they have an eating disorder.  That you just, you can't tell by looking at someone.  
Another way you can combat weight stigma is use terms like people in larger bodies or higher weight people, rather than the O words.  And focus on complimenting people's character and internal strengths, rather than weight loss.  
So really just I would suggest not focusing on appearance at all, or weight, and really just focusing more on the qualities that people have that the last story that I read or the one before that kind of talked about how harmful it can be to compliment weight loss.  You never know when you are complimenting someone's eating disorder or someone's illness or a decline in mental health that has resulted in weight loss.  So it's really helpful just not to focus on that.  
Next slide.  And these are all ways that you could be contributing to someone's eating disorder, all things that are kind of done in our culture.  That, you know, if you made the choice to kind of notice yourself doing that or notice others doing that, and challenge it when it happens.  That could be really helpful.  This isn't like to shame anyone for doing any of these things.  Because these all are ingrained in us in a lot of ways and we are told that we should do some of these things.  Are told that it's okay, or not that big of a deal.  But it's more just to help you be aware of ways that you could potentially reduce some of these behaviors, and act in a more positive way and be more supportive toward people with disordered eating.  
So making fun of someone's eating habits or food choices, um, compliments weight loss, we talked about that.  Labeling foods as good or bad.  I would add to that labeling them healthy or unhealthy.  The reality is all foods have something of nutritional value, that our bodies can use.  We do need enough calories to survive, and calories in and of themselves are a nutrient in a lot of ways.  All foods have carbs, protein, or fat, which all of which we need.  So just kind of looking at foods as being good, and being a way to nourish ‑‑ nourish our selves rather than something to shame people for.  Placing judgment on the bodies of others.  Responding negatively to changes in others' bodies.  Encouraging healthy ‑‑ unhealthy fitness habits.  So really any type of exercise that you are encouraging, um, that is for the purpose of like weight loss or for the purpose ‑‑ I think in our culture.  A lot of people say I need to go run so that I can burn off X food or if I'm going to eat this, then I need to exercise after, which kind of promotes this disordered idea that you have to earn your food, rather than just acknowledging that we all need to nourish our selves and exercise and movement can be a positive thing.  It can be a positive way to improve our mood or feel better it's not something we need to do to earn our food or to meet a certain standard.  
So just avoiding encouraging that.  Criticizing your own eating habits or weight.  I think this is a really important one.  Because I think this is one that is really encouraged in our culture.  We are constantly kind of told that it's okay, or acceptable, or it's often a way to kind of fit in or even just like make small talk to be like I'm so bad I just ate X or I really shouldn't be eating X, why.  Z.  But you never know if someone is disordered eating or someone in a larger body is hearing that, and that might negatively impact them.  And someone in a larger body might be hearing that as like, oh, you don't want to eat a certain food and become larger and have a body that looks like theirs, like that might ultimately be the implication.  
I am not sure what happened to Kathryn.  
>> Can you hear me?  
>> Yes.  I think I lost you for a second.  
>> Okay.  Do you want me to go back?  
>> If that's okay with you.  
>> Yeah.  Sorry.  
>> Thank you.  
>> The one on the side if you can just click that.  
>> This one?  
>> It's the one above this.  
>> Yes.  Okay.  
>> Okay.  Yeah.  So we were at like criticizing your own eating habits or weight.  I think that can come across as like, I don't want to look like someone in a larger body, or I don't want to eat something that will make me look like that.  Or, you know, saying, it could come across as saying this food is bad or unhealthy for all people.  
Another big one is assuming that someone wants to lose weight, or change their body, um, just kind of making that assumption based on body size.  When that may be not be the case at all.  Expecting perfection.  Just kind of holding people in general to rigid standards around food and around weight, but also around just general life things, I think that can contribute to lots of different mental health issues.  And then lastly speaking negatively about bodies.  Just in general kind of categorizing bodies as unhealthy, or healthy, or I don't want to look like that, or I do want to look like that.  I think just trying to stay positive about bodies and a diversity of all different types of bodies can be really helpful.  
Next slide.  So this is more kind of, it says Thanksgiving convo tips, but it can just be for life in general.  So some things not to say.  I'll have to run a mile after all that food.  As I kind of mentioned before, we don't need to earn our food.  We don't need to punish our selves for eating.  And yeah.  We all need to nourish our selves regardless of how much exercise we do or don't do.  My diet will start tomorrow, and today I'll be bad.  That is, I think that is really commonly said on holidays, but just like in general.  But the reality is that there are no bad foods.  And you aren't bad for eating something.  There is just food and all foods can be part of a healthy diet.  I didn't eat all day, so now I can eat this food.  You don't have to restrict yourself in order to nourish yourself.  That is really important.  And then kind of this idea of like policing other people's food.  Careful that is a lot of fat and sugar.  Bodies need fat and carbs and sugar, and it's good and healthy to eat what your body is is craving, especially on holidays.  They are an important part of many holidays in many different cultures.  So that is positive.  
And just in general, like policing people's food or commenting or even saying something like that is a lot of food, or that is not a lot of food.  Or you are eating so much.  In general that can be really harmful.  So just focusing on the conversation, rather than the food can be helpful.  
Next slide.  I also wanted to just share some information about combatting weight stigma and mental healthcare.  So this is specifically for mental health advocates, mental health clinicians, disability advocates, people who work in and around mental health services.  So one strategy for combatting weight stigma in these spaces is to advocate for and provide weight inclusive care that acknowledges the impacts of weight stigma on mental health and that is really affirming toward people of all body sizes.  There is some really good resources on kind of how to provide weight inclusive care.  There is a paradigm called health at every size that many healthcare providers use to really provide that kind of affirming care and just promote healthy behaviors, and people of all sizes, and not focus on weight.  So I would definitely recommend looking into that.  Make sure size diversity is included in diversity and inclusion initiatives.  I often see size missing.  So just really making sure that is part of being inclusive.  Advocate for mental health settings to be accessible to people with larger bodies.  I think this is one way that weight stigma really intersects with disability rates and disability justice.  Is that we really need to make sure we have large enough chairs, large enough gowns and inpatient settings, large enough office furniture, and things like that.  And also like on websites, for mental health services or mental health providers, and the building like if there is pictures or magazines, that they are showing people in larger bodies, and  in a positive way, there is a diversity of body sizes included and represented so that people know they are welcome.  
Challenge the promotion of weight loss and dieting within mental health settings.  There can just be a lot of that.  Sometimes therapists will tell people in larger bodies, therapists, psychiatrists, other mental health providers, to lose weight as a way of managing their mental health or even like in peer services, people can refer to different groups or diet groups or even like 12 step programs that are encouraging people to restrict their food, and not necessarily to have a healthy relationship with their body size and with food.  So really challenging that.  And making sure people know the value of promoting size acceptance, and kind of a more positive approach to food in all settings.  
And advocate for insurance coverage of eating disorder treatment for people of all body sizes.  This is a really big issue that people in larger bodies with eating disorders are often denied coverage of care because of the influence of this stereotype of who really does have an eating disorder, and how severe eating disorders are.  This idea that that can be determined by body size so really advocating for other criteria besides that to be used to determine insurance coverage or better yet, advocating for universal healthcare where that is not necessarily people aren't being denied coverage for certain services that are really needed.  
Next slide.  And then there is just ways to challenge cultural weight stigma, which really anyone can do regardless of your specific role.  So speak out about the harmful effects of weight stigma.  I think people don't really know often their, this topic just isn't often spoken about.  And we don't really think about it a lot of the.  We often are just told being in a higher weight is bad.  Being in a lower weight is good.  That is that.  That is all the information that we are kind of given.  So really speaking out about how harmful that is, and sharing any knowledge you have about how it's more complex than that.  
Follow and share the work of fat activists, healthcare professionals and recovery advocates.  You can definitely look up lists of, there is a lot of lists that people have put together of fat activists and healthcare professionals, and eating disorder recovery advocates.  That can definitely be a really good way to promote, yeah, promote messages that are challenging weight stigma.  
And then challenge mis conceptions of weight stigma and eating disorders you hear in your workplace, school or every day life.  Just whenever you have the chance, sharing the ‑‑ that that is not the case or things are more complex than just higher weights being negative.  
Next slide.  Did I freeze?  
>> Yeah, I think so.  
>> Okay.  I'm not seeing the next slide.  
>> If you want to go to the next slide.  So these are some great references.  The national eating disorder association has a really good page on weight stigma that just gives an overview, um, there is some really good statistics from the national eating disorder association and from the national association to advanced fat acceptance.  I would recommend looking into both of those.  The obesity action coalition, which I really do not like that word.  They have some good statistics, and some good information on the impact of weight stigma.  So that could be helpful to look at.  But in general, I would definitely recommend looking at the national eating disorder association, and NAFA if there is more updated information about weight and they are not using some of the language like the O words.  
I actually cowrote a piece on combatting weight stigma in mental health recovery spaces, and like specifically peer‑led spaces.  With a few fat activists.  And that is on medium, so that is that piece right there.  Too might be helpful for those of you coming to this from the peer movement, or from being a peer specialist, or who want to get involved with that.  Because I think there can be a lot of weight stigma in those spaces just as there is in any space.  And then next slide.  These are three resources that I highly recommend for further reading and learning.  The food pod cast is hosted by the dietitian Kristi Harrison who talks about health at every size and intuitive eating, which are kind of ways of eating and engaging in the world and then healthy behaviors and providing healthcare.  And ways that are affirming of all weights and sizes.  And every episode she has either like a fat activist or eating disorder recovery advocate, or eating disorder therapist or dietician come on the show and kind of share a different perspective and that is something that has been super helpful to me and to many, many people in eating disorder recovery, and doing body acceptance work.  So I highly recommend that.  Also the association for size diversity and health, and the national eating disorders association.  Next slide.  Yeah.  So yeah.  
>> So that is it.  Thank you.  We really appreciate you.  This is an awesome presentation.  We really appreciate you taking the time to get all this information together.  I'm sure everyone enjoyed it.  I know I did.  I learned a lot that I did not know.  And things that I will not do anymore.  Or at least be more mindful of it.  
So we are going to move on into the questions and answers.  For those who are joining us by Zoom, online, you can ask your question by raising your hand.  Wait for us to call on you and then unmute when you are prompted.  And for those who are over the telephone, you can ask your question by pressing star 9 to raise your hand.  Wait for us to call on you and then press star 6 to unmute yourself.  I'm going to start off by just giving you what we have in the chat.  I have a couple of comments, I'm just going to read real quick from Gina, Gina said, how great this awareness is happening now.  I suffered my whole life and then we had a comment from Robin that said she had to leave to exit the call, but I really thank you all for presenting this on this topic.  I have a saying, her saying is I wear fat like a fur coat.  And this little diddy has served me well throughout the years.  So that is Robin saying.  Thank you Robin.  If you are not on anymore, but I did let her know that we appreciate her attending.  And Gina, thank you for your comment.  
There are some Q and As that I'm going to read off to you.  Again, Robin says, this is great information, I'm glad we are willing to have this conversation.  I would like to have a copy of the slide signs you may be contributing to someone's ED.  So will that be available, Shira?  
>> I can definitely send the slides to whoever could put that on the website.  And that can just be on the website.  I know that graphics specifically is from body brave Canada if people want to look that up.  I think it was shared on their Instagram.  
>> Okay.  Thank you.  From lawyer rel, she made a comment, I am watching a class ‑‑ I am watching a class online for student in nutrition, her first class she mentioned to look at food not good or bad.  And that we will all need each food group.  It was interesting that you focused on that, first time I have ever seen it.  Okay.  
>> Awesome.  
>> And also Laurel, I'm not sure if she had a question.  She said since COVID my family members has started to drink beer at 11 AM to fill herself up to avoid eating until dinner.  Because I'm working from home, I am not on a work schedule and she has been more on a laid back lifestyle as well.  It has an impact on her life.  So I don't know if you want to just comment on that. 
>> Yeah.  For sure, I mean, I think COVID is just because of the pandemic, and all of the changes that have happened, we are seeing a lot of increased disordered eating and that is definitely I think we are seeing increased substance use, too.  Those can intersect, that sometimes people do use substances to avoid eating.  
So yeah.  I imagine that has a huge impact and I'm sorry that you are going through that and that your family member is going through that.  Yeah.  
>> Okay.  Thanks, Shira.  The anonymous person, thank you so much for speaking on this topic.  And the importance of understanding how weight stigma impacts mental health.  Can you talk about ways to combat white supremacy within weight stigma and an eating disorder education?  
>> Yeah.  Definitely.  I think the eating disorder field is predominantly white and there is not a lot of black therapists and black dietitians and black researchers in the field.  So that really needs to change.  I think there are some initiatives happening to try to get more people of color into the field, and provide different scholarships and opportunities.  So we definitely need more of that.  For resources on that, again, I definitely want to recommend fearing the black body, which kind of details how the history of how we have thought about weight for the past several hundred years.  Is really due to racism.  And so I think that is a really important read.  It is pretty academic.  It reads more like a dissertation, so if that is something that you might not prefer, I think the author, Sabrina Strings has done a lot of interviews and talks on different pod casts.  She's written some articles.  So I really highly recommend that.  Because I think that is something that really needs to inform the eating disorder world, and the eating disorder field.  Another great like body liberation activist who also talks about it from an enter sectional approach, and talks a lot about white supremacy supremacy, and Sonia Taylor.  And then there is a dietician named Jessica Wilson, and she has been sharing a lot about kind of white supremacy and the eating disorder field and how that I am packs things and we how can challenge it.  She has a pod cast called my black body.  So I highly recommend her work, too.  
>> Okay.  Thank you.  One more for the chat, and then we have a few raised hands.  Thank you Wendy says thank you for, for the information.  Are you going to be providing certificates?  
>> I am not sure about that.  Yeah.  Maybe Kathryn would be able to answer that.  I don't think so.  
>> We didn't apply for continuing education credit for tonight's presentation, if you need verification that you attended, send us an e‑mail and we can do that for you.  
>> Okay.  So we have Patrick, go ahead, Patrick.  
>> Good afternoon, good evening, can you hear me?  
>> Um‑hum.  
>> Yes.  
>> Yeah.  Good evening Shira, good evening.  I'm really glad to have been participating in this presentation, it was really great.  And actually I do have a question like how do ‑‑ how can to put it this way you can address some body positive activity on people with autism, because sometimes I mean not all, I would say they can be oblivious around the world that they live, and sometimes I mean, they cannot discern whether someone is maybe saying something derogatory to them, like when it comes to like you know, let's say their body weight, let's say either they are big or small, and like sometimes I mean, they  ‑‑ their feelings can get hurt.  How is a good way to let's say help them like say, um, not listen to those people that would say something derogatory to them.  
>> I think that sa really good question.  I think that kind of like I mentioned, weight stigma disproportionately impacts people in marginalized groups and certainly disabled people are a marginalized group, impacted, I think extra by weight stigma.  And I think weight stigma can intersect a lot with able ism.  Especially like against autistic folks and people neuro divergent people.  Sometimes people are told, I've certainly had the experience of being told that if I dieted or if I lost enough weight or if I ate only clean foods or whatever, um, then I wouldn't be experiencing as many mental health issues, or I would be less neuro divergent, I think this topic is important for autistic people, all people with all disabilities.  So I'm really happy that you brought that up.  
But, yeah, I think there just needs to be more awareness about that connection.  And more of an understanding, I think often like eating disorder treatment providers, and mental health providers in general, as well as like educators, who are working with that population, may not really have learned about weight stigma and how it might have a negative impact.  So I definitely think that is an area to work on, to increase that.  
I also wanted to mention there is a lot of people doing work around both neuro diversity and like weight stigma.  The person who immediately came to mind to follow is Noreen Hunani.  I can put that in the chat.  She is a neuro divergent dietician.  She talks about ‑‑ she talks about how important it is for both issues to be talked about.  So thank you.  
>> Lauren, you can go ahead.  
>> Lauren, are you there?  You can unmute yourself.  Are you there, Lauren?  I'm going to go to Denise, and then I'll come back to Lauren once we get that figured out.  Denise?  
>> Hi.  I appreciate the fact that you taught about language, about language how not to ‑‑ not to identify with the food that you eat.  I appreciate that part.  And what you said to somebody who has that who lost the weight and who can ‑‑ who you do not know why they lost the weight.  I appreciate that.  I'll be mindful not to shame certain things to that individual.  
>> Were you finished, Denise?  
>> Yes.  
>> Sorry.  Did you have a question?  Or. 
>> Not a question, more like a comment.  
>> Okay.  Yeah.  
>> What it was that ‑‑ what it was that you presented.  I have a ‑‑ I have a disability, and I am a disability advocate.  So I can ‑‑ I do not like it when people say, oh, you are I am so proud of you because you achieved certain things.  So I appreciate not saying certain things.  I appreciate what you said about understanding about the individual what they eat, or they lost the weight.  
>> Awesome.  I'm glad that was helpful.  And, yeah, I think there are a lot of parallels between like size ism and fat phobia, and able ism and some of the things that people say to both groups.  So I appreciate you pointing that out.  
>> Right.  
>> Thank you, Denise for your comment.  Okay.  Lauren, are you there now?  
>> I think so.  
>> Okay.  
>> Can you hear me?  
>> Yes.  
>> Yes.  
>> Sorry.  But I have two things, first thing is that I'm a blind person so I couldn't see the slides, and I wondered if there was some way that you could e‑mail the text of all of this to me, because I think I missed out on quite a bit of what was presented. 
>> Yeah.  I definitely would like to do that.  I mean, I can definitely e‑mail those slides.  I think they are going to be posted on the website.  But I don't know if you need like a file in like word. 
>> I need the text.  
>> Okay.  Yeah.  
>> We can do that.  Yeah.  Absolutely.  No problem.  Thank you, Lauren.  We can do that for you.  Not a problem.  
>> Thank you.  
>> Okay.  And then the other thing is that I have ‑‑ I have so much trouble with medical people, and I had a pain specialist tell me he couldn't work with me anymore because I had to lose weight or they wouldn't do a hip replacement.  And so he just dropped me from his practice.  And that was really hard on me to deal with that.  And I also had the same kind of thing with an orthopedist who treated me really badly, and said that I was really too big, and too disabled, and all of that.  But except he used the word hand capped which I don't like.  And he never did, you know, acknowledge my person hood at all.  And so, yeah, I'm wondering if there are surgeons anywhere who will do hip replacements on a person who is plus sized, you know, because they just, you know, all of them tell me no.  That I have to lose weight first.  
>> Yeah.  I'm really sorry that happened to you.  That is awful.  And it sounds like a terrible experience.  But, yeah, I ‑‑ there is a directory of like health at every size aligns provider that are committed to providing weight inclusive care.  I can maybe we can post that on our site, but I think it's the website is called like Hayes community and there is a directory, so you may be able to find. 
Q.	What is . 
>> What is the website called.  
>> Haes, health at every size community and there is a directory on it.  But. 
>> Hey every size community. 
>> Health at every size.  
>> Health at every size.  
>> Yeah.  He  E ‑‑ yeah, so you may be able to find a physician on there.  I think ‑‑ yeah.  Thank you Annette.  I think last I checked there is not like a ton of resources in Florida.  But. 
>> I'm not in Florida.  
>> Oh, okay.  
>> So how would I find. 
>> You can search by state.  So hopefully maybe you are in a state with more resources.  Yeah.  And then also sometimes I've seen posts like that on like Facebook groups.  There are Facebook groups for health at every size, specific groups, where you may be able to post and kind of say what kind of physician you are needing, and see if anyone knows of any specialists or anyone who even just might be able to refer you somewhere if you met with them.  So yeah, but I would definitely see if you can find a provider if possible.  
>> Okay.  Thank you.  
>> Yeah.  Thank you.  
>> Thank you, Lauren.  Okay.  I think I got just a few more comments.  Patrick, who you just who asked the question said, it was an excellent presentation.  Because I work with young adults with disabilities, that needs this type of body positive  talk.  Thank you for that, Patrick.  
>> Thank you.  
>> And then also we have Maria says a friend of mine has an eating disorder and started gaining a lot of weight.  He was very skinny a couple of years ago, and I have seen that her daughters are kind of coping with her behavior.  How can I help the girls to avoid having an eating disorder?  
>> Yeah, I'm sorry your friend is going through that.  And that is great that you want to maybe provide some resources.  Yeah, I would definitely say referring them to any of the resources at the end of the PowerPoint, especially the national eating disorder association.  Could be really helpful.  Just so that I think the national eating disorder association has a directory, too, of like eating disorder providers.  If they are wanting to get therapy or see a dietician.  It also has really good information.  The aligns for eating disorders is another good resource.  And then definitely the association for size diversity and health.  So, yeah, I think maybe just providing some resources and sharing anything you know of that could be helpful.  If they are open to that.  
>> Okay.  Thank you.  Well, also, Shira, Patrick wants to know do you do this presentation to, for other organizations?  
>> Yeah.  I do.  I think I just raised my hand.  Yeah.  I do.  This is something I do a lot of different like presentations on weight stigma, health at every size, eating disorders, so please feel free to connect with me if that is something you are interested in.  
>> Okay.  And let's make sure I don't have anybody else.  No more hands raised.  I don't think I missed any other questions.  Let's see.  I think that is it.  
>> I am just going to type my e‑mail in the chat in case anyone wants to get in touch, if you have further questions.  
>> Okay.  So, and Kathryn, I think you did place that this will be on the website?  
>> Yes.  This is going to be on the website.  There will be a page devoted to the topic with some further reading resources.  As well as a link to the blog that you wrote, Shira, and also the pod cast.  That you recorded on this topic, which is really informative, and interesting to listen to.  And we will certainly provide an option to Lauren and others who need the text only version to help assist with reviewing the slides.   That were presented tonight.  
>> Okay.  And Lauren has another question.  
>> Yes.  Could you say the e‑mail address and the website?  
>> Yeah.  It's SHIRA dot Collins at G mail .com.  That is mine.  And then. 
>> What was it again?  
>> SHIRA dot COLLINS   GS at G mail .com.  
>> Okay.  
>> And then I don't know disability rights Florida's website off the top of my head.  
>> That's okay.  It's disability rights Florida dot org.  So you should find it.  If you just type in disability rights Florida it will take you right there.  
>> Okay.  Thank you.  
>> Sure.  And we can e‑mail you directly, too, Lauren, I think we have your e‑mail from the list of attendees, okay?  
>> Okay.  
>> Thank you, Lauren.  
>> I just want to thank everyone who attended and thank you so much Annette and Kathryn.  For helping mod rate and sharing your slides, and thank you so much to our interpreters, as well.  And Valerie and mckenzie.  I appreciate all you did.  I really enjoyed it, and super grateful to be able to share this with disability rights Florida.  
>> All right.  Thank you, Shira, you did an awesome job.  We really appreciate you.  And I'm sure this information is well needed.  I think everyone that attended this evening, I think everyone that participated at the questions, we thank you, and we thank you Kathryn, and everyone for helping us be able to successful ly put on this presentation.  Look on our website for more webinars that we will be doing in the future.  
>> Kathryn, any last minute thing. 
>> No, that's it, thank you everybody for coming, we appreciate you, and we really appreciate our advisory council share, chair and vice chair, you two are really invaluable to the work we do here.  And thanks for your knowledge and your, you know, your  your constant enthusiasm and help to our community.  So thank you.  
>> Thank you.  I just wanted to also add I know the person who I believe was Wendy who asked about the certificate, she was saying something about a CEU s, so I'm not sure what we do with that, Kathryn. 
>> I can e‑mail her.  We did not apply for CEUS, this wasn't that type of presentation.  But if there is anything we can do in terms of providing information to assist her, I'll, I'm going to reach out to her and see what we can coordinate.  Okay.  Tough.  
>> Sure.  Everyone thank you, and have a blessed and wonderful evening.  And we thank you again, look forward to seeing some of you at our future presentations.