Ep. 14: Radical Dietician - Lucy Aphramor

EB014  The Radical Dietician - Lucy Aphramor

Lucy Aphramor is the Radical Dietician and the Naked Dietician. She believes we must fundamentally change the way we talk about health. In her Well Now approach, social justice and equality become the center and beginning of every conversation about health. For example, how can we talk about food and exercise without talking about access? Her approach integrates social factors, pays attention to trauma, and supports people to improve their overall wellbeing. The Well Now approach has effectively helped people of all shapes and sizes manage health conditions such as heart disease, Irritable Bowel Syndrome (IBS), high blood pressure and so much more. Additionally, she has effectively helped hundreds of people overcome body shame, eating disorders, and depression by staying committed  to promoting respect, dignity, and equality for all. 

Lucy was the figurehead at the Health at Every Size movement and is co-author of the book Body Respect with Linda Bacon. 

She joins me today to discuss her current model - Well Now - and what has inspired her to become a dietician. She shares her insights on how the stress of prejudice can play a role in health, how she brought the Health at Any Size approach to the National Health Service, and the impact historical trauma can have on health and so much more. This episode also uses clips from Lucy's poetry performance, The Naked Dietician.  

“Telling your story to a caring witness has a metabolic impact... that switches off the stress response.”

- Lucy Aphramor

This Week on the Every Body Podcast: 

  • The importance of looking at all parts of a person’s story struggling to overcome an eating disorder 

  • Studies that show that our health behaviors are between 5% to 25% of the difference in health inequalities 

  • Why finding a way to bring social justice into the healthcare system is important 

  • How changing the language around weight loss and weight correction can impact body positivity and self-esteem challenges around the world 

  • How thinking about well-being from a justice, power, and historical trauma lens can impact the way we think about health 

  • How Well Now helps people get away from the binary mindset about what’s healthy and what’s not healthy 

  • Conversations that need to be happening in our society 

  • Where she believes intervention needs to start 

Connect with Lucy Aphramor: 

 

FOLLOW UP QUESTIONS FROM INSTAGRAM

Question from fatbodypeace
Will those poems be in print somewhere?

Response:
Yes. The poem is in the book “Raise the Roof’. I can send details about how to order a copy if you’d like: just email me at  lucy.aphramor@gmail.com


Question from jilllepire: 
Is it ever okay to try to change your physical body while being body positive? If so, how does one do that without being sucked into diet mindset?
Response: 
Hi Jilllepire,

Thanks for your question.  In fact I talk about body respect in my work, rather than being body positive, so I can’t speak for body positive folk. One reason I focus on respect is that I think the idea of being positive in this context can easily get to be about rules - pretty much as you highlight in your question, and this gets in the way of what is intended. It can mean people feel they are failing if they don't feel positive all the time, or, in your case,  failing because you want to change your body. Hmm. That’s a stumbling block  in terms of encouraging self-acceptance.

To my thinking, it’s ok to explore whatever it is we feel we need to (with the hope that we’re always able to keep ourselves safe in this). This is what I mean by body respect - that we respect our body’s direction and are curious about what we feel drawn to, and notice our impetus eg. to change, without judging ourselves, knowing it holds meaning for us even if part of that meaning  escapes us right now. In other words, I believe there is always a healing purpose in our desires and actions, though this drive to healing may not be immediately obvious. So, wanting to change contains within it the drive to repair and connect. Maybe we were told we had to look a certain way to be ok. Wanting to change to be that way makes good sense to a part of us trying to protect ourselves. The desire makes sense, but the outcome we wish for may not be possible. This can be a hard dilemma to sit with. If we’re able to notice the conflict from a place of compassion - and especially if we are able to check in with folk who help hold us in this place - then we are aligned with our drive to heal, and can start to make sense of our experiences in a way that is meaningful. The need to be different, and to get things 'right’ has served/serves a purpose.  As we get more comfortable  sitting with ambivalence and acceptance we can explore this, and find new persecutive and choices.

I wonder how things might feel different if you switched from a focus on changing the physical aspect of your body, onto noticing the feeling part of your body. Questions might be “what will I feel better for?” instead of “what should I do to [look better, get leaner, bulk-up,or whatever]."

For me, I hear the diet mindset in the idea “I’m not doing it right if I can’t follow the rules” or “I’ve failed if I have ambivalent feelings”. e.g.. “I’m not body positive if I want to change my body”

The deep thinking of the diet mindset is “I’m not good enough because ….” I think we can always experiment with being gentle and curious with ourselves, letting go of blame and the idea of failure, including when we wish we were different. The core point I return to is that you are ok. Whether you are body positive or not. Whether you sign up to body respect or not. Whether you spend a life time wanting to change your physical body. Your worth as valuable human being deserving of love and respect and compassion is  indisputable. You are  good enough. You always will be and you always were. And I’m sorry you lost, or never got to, knowing this. Reminding  ourselves and each other of our innate humanity is my take on letting go of the diet mindset.

Here’s part of a poem I wrote that gives more context to my ideas:

"right in this room a million women hours have dragged past in our thoughts of being more by being leaner cleaner slimmer trimmer thinner thinner thinner     Shame - I was taught your contours–I was not born calling any flesh excess

whoever you are, however much you wish your body different I count you in when I ask which of us has value   through all the stages of the selves you would create    your worth holds fast, your worth is stable, unchanging, innate"

When we know this, we loosen the grip of the diet mindset, and can grieve its passing and acknowledge the role it played in getting us here.

I hope there is something in here that is useful - even if it’s because you disagree! That’s ok, it means you are learning to trust yourself, which is great. I wish you all the best as you find your way back to inhabiting your okness.

warm wishes

Lucy


Question from wee_foodies: 
I’d love to hear more from her around the evidence base on the biological impact of weight stigma and ways to challenge the “tackling obesity” conversation in public health.

Response: 
Hi. There’s lots of research data around the biological impact of weight stigma. First, there is general info that shows living with stigma/chronic stress has a detrimental impact : this is psychological/physiological. The fact that a particular group is being discriminated against also has broader human right implications and social impact of course. 

 I’m most familiar with the evidence on stigma/chronic stress and heart disease, and the Whitehall studies is great reference source. A key researcher is Michael Marmot, he coined the phrase ’status syndrome’  to account for the fact that living with the stigma of low social status impacts health.

Second, there is data on weight stigma per se. A useful overview paper is https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2386473/ though there’s some inconsistencies in the theory presented. In more detail  “  stress-induced activation of the hypothalamus–pituitary–adrenal axis increases cortisol production which exerts hyperphagic and antithermogenic effects. Differential rates of responsiveness to cortisol between abdominal and subcutaneous fat, together with hormonal and enzymatic changes, mean that stress responses preferentially favour abdominal fat deposition. In healthy individuals, acute stress does not appear to lead to deleterious effects, but repeated stress may lead to long-term changes that predispose to metabolic syndrome, especially in people who are insulin resistant. On perhaps a more familiar level, stress is known to affect eating behaviour, food choices and gastrointestinal disorders (Murcott, 1998). In addition, there is recent evidence that mental stress may trigger peripheral inflammatory responses which subsequently increase morbidity and mortality (Tappy et al ., 2004; Black, 2003). In  Aphramor, L. (2005b). Is a weight-centred health framework salutogenic? Some thoughts on unhinging certain dietary ideologies. Social Theory and Health, 3 , 315-340.

Weight stigma has biological impact through metabolic consequences of chronic stress, and through influencing health-seeking behaviour. Work in Fat Studies e.g. the Fat Studies Reader ed. Solvay and Rothblum, are good sources of info for this. 

I’ve also attached an article I wrote that addresses this interlink  (my thinking has changed on what HAES is since I wrote this, but the gist of the argument can still be useful).

What have you found useful and less useful changing the conversation? I find challenging deep assumptions by asking questions can engage people in conversation, rather than lead to a reflex defensiveness. I ask things that lead us to untangle the impact of behaviours and social factors (including respect) on health, and explore the real-life impact of weight-correction on dieters’ health, sense of self, and on how this enhances justice or normalises oppression.

There’s a video on my website (“untangling health, respect, behaviours’) where I go into this in more detail. 

I have also found it  really helpful to ask questions that bring the health impact of eg. trauma and agency (having meaningful choice) into view.  eg. In a room of 100 people,  if we all eat and exercise the same, but some of us go home to violent relationships and some of us to loving relationships, will our health outcomes be the same etc. I find helpful to frame things in a way that helps people articulate a new perspective for themselves, and opens up dialogue, rather than ‘feeding facts’ . In this scenario, at a very basic level they discover there’s more to wellbeing that diet & activity, which starts to disrupt the assumptions of weight correction agendas.

I hope some of this is useful, and wish you all the best in your work.

Question from wanderingdjinn: 
Does Lucy have a script for confronting one's parents about the damage they've done by commenting on one's weight and appearance almost daily, starting at a very young age? I've let go of a lot of my anger towards them and I'm in a better place, but I worry that they're continuing to make weight-related comments to my much younger cousins, and will start on my nieces in a couple of years, if they haven't already. I really feel I should speak up to protect them, at the very least by no longer hiding all the self-destructive things I've done as a result of the self-loathing for which they planted the seeds. My fear, of course, is that they won't believe me, will insist they were in the right, and that I was/am just being too sensitive.
Response:
Hello wanderingjinn. I’m so sorry for how you’ve suffered as a result of your parents’ actions. This shouldn’t have happened. And the fact that it is still happening is appalling, and sadly also understandable in that it fits with the cultural script of judgement and inadequacy that we are born into. It’s really heartening to learn that you’ve been able to identify this as wrong and find ways to move away from it. Bravo you.

When I first started realising the mess we were in with weight, and trying to change things, I confronted colleagues with the damage  we/they were wreaking. I slowly learnt that confrontation mainly led colleagues to shame and they retreated or attacked, benefiting no-one. Now I seek to start a conversation that enables engagement instead. I believe we need conflict, otherwise we support the status quo. But I avoid framing things in a way that implies  I think they are wrong and I am right. Instead I ask questions, often about feelings and consequences, intentional and unintentional. In doing so, I want to enact an open-minded curiosity, the same curiosity I am inviting the listener to engage in, without fear of judgement. This isn’t about dumbing things down - I hold very strong views, I think we need to acknowledge harm has been done, and I am passionate about the need to change! 

When I look to the deep roots of what I am doing, I can see that if I try and impose my view (however right I believe it to be) then I am enacting conquest and domination. I know I am skipping through things, and it can seem a bit of a stretch, but this drive to conquest is the root of stereotype, binary thinking, judgement, fascism .  So I aim to start a conversation without any agenda to change the other person, whether colleague, parent, client etc. My agenda is for real dialogue, the hope that we meet each other in the difficult places. The paradox is that by withdrawing from the need to change someone, change becomes more possible. In this way we foster true emancipation.

Having folk to connect with for a reality check, for comfort, for sustenance, supports me in this approach. At heart, I see what we are doing  - building a fairer world, healing from shame and disconnect, living a vision for peace  - as Love’s Work. Compassion is therefore essential, starting with self-compassion. This enables me to feel the grief, loss, anger, outrage without being crushed by it. To find compassion for those who harmed me, whose fresh actions hurt me, who continue to silence me, who would still harm me if that’s what it came to to protect their world view. To know when to stay and engage, when to let be, when to move on. When I practise compassion I am more able to open conversations about harms done in ways that offer alternatives to harm. So, a long answer to say I’m afraid I can’t offer a script but I’ve found the (Well Now) way markers of 'your story matters', compassion, curiosity and connection help me build paths I want to travel in the direction I want to go.

As a few real-life pointers:

  • Could you reflect back a comment to ask your parents about what weight means to them personally?
  • Or start a conversation about weight where you recall times they tried to help you with your weight (in inverted commas of course, though the intent may well have been  to help), link this to your younger relatives and ask if they want to know what you’ve found out that is useful? And share some of how it can be/has been damaging?

It would be great if there was someone you could role play this with first. Above all, of course, look after yourself. 

warm wishes

Lucy

Question from wee_foodies
Loved the interview. I'm a nutritionist working in public health and getting increasingly uncomfortable about the "tackling obesity" agenda. Would love to hear Lucy's thoughts on ways to challenge this and begin changing the conversation.
Response:
Hi, Thanks for your question. I’m glad you liked the interview. It was my first podcast: I learnt a lot about being on a podcast from listening to it!!

When I first started realising the mess we were in with weight, and trying to change things, I confronted colleagues with the damage  we/they were wreaking. I slowly learnt that confrontation mainly led colleagues to shame and they retreated or attacked, benefiting no-one. Now I seek to start a conversation that enables real engagement instead. I believe we need conflict, otherwise we support the status quo. But I avoid framing things in a way that implies  I think they are wrong and I am right. Instead I ask questions, often about feelings and consequences, intentional and unintentional. In doing so, I want to enact an open-minded curiosity, the same curiosity I am inviting the listener to engage in, without fear of judgement. This isn’t about dumbing things down - I hold very strong views and am passionate about the need to change! When I look to the deep roots of what I am doing, I can see that if I try and impose my view (however right I believe it to be) then I am enacting conquest and domination. I know I am skipping through things, and it can seem a bit of a stretch, but this drive to conquest is the root of fascism, stereotype, binary thinking . (As an aside, this makes me  wary of any ideology that silences critics. After all, maybe I did miss something, and if I want a world based on respect then I want to find ways to respect someone’s view -even though it’s wildly different to mine.) I start a conversation without any agenda to change the other person, whether colleague, client etc. My agenda is for real dialogue, the hope that we meet each other in the difficult places. 

The paradox is that by withdrawing from the need for domination we foster true emancipation.

I’ve found activist writing on non-violent change really helpful. Successful change needs analysis (I can do this to death!), strategy, vision. For vision, whenever possible I speak of/enact the change I want. eg.  I cite NHS Highland as example of mainstream healthy weight services that are inclusive and focus on health in its broadest sense, and promote body respect. 

Having folk to connect with for a reality check, for comfort, for sustenance, supports me in this approach. At heart, I see what we are doing  - building a fairer world, healing from shame and disconnect, living a vision for peace  - as Love’s Work. Compassion is therefore essential, starting with self-compassion. This enables me to feel the grief, loss, anger, outrage without being crushed by it. To find compassion for those who harmed me, whose fresh actions hurt me, who would still harm me if that’s what it came to to protect their world view. To know when to stay and engage, when to let be, when to move on. When I practise compassion I am more able to open conversations about harms done in ways that offer alternatives to harm. So, a long answer to say I’m afraid I can’t offer a script but I’ve found the (Well Now) way markers of 'your story matters', compassion, curiosity and connection help me build paths I want to travel in the direction I want to go.

What have you found useful and less useful changing the conversation? I find challenging deep assumptions by asking questions can engage people in conversation, rather than lead to a reflex defensiveness. I ask things that lead us to untangle the impact of behaviours and social factors (including respect) on health, and explore the real-life impact of weight-correction on dieters’ health, sense of self, and on how this enhances justice or normalises oppression.

There’s a video on my website (“untangling health, respect, behaviours’) where I go into this in more detail. 

I have also found it  really helpful to ask questions that bring the health impact of eg. trauma and agency (having meaningful choice) into view.  eg. In a room of 100 people,  if we all eat and exercise the same, but some of us go home to violent relationships and some of us to loving relationships, will our health outcomes be the same etc. I find helpful to frame things in a way that helps people articulate a new perspective for themselves, and opens up dialogue, rather than ‘feeding facts’ . In this scenario, at a very basic level they discover there’s more to wellbeing that diet & activity, which starts to disrupt the assumptions of weight correction agendas.

I’ve attached a couple of articles that might be helpful in moving public health conversations away from weight-correction and towards acceptance and equity. There’s more on my website.

I hope some of this is useful, and wish you all the best in your work.

In Peace

Lucy

Question from littletulipsco
l'd like to know how Lucy thinks we can build our self compassion in really practical ways (like a list that I can follow!) And also if it's okay to want to lose weight. It feels like if you were fully accepting of your body you *shouldn't* want to change it. But I was at a kindful eating workshop with Lucy and she was all about questioning *should* self talk. Does that make sense? Thank you!
Response:
Hi littletulipsco,

Ah, self-compassion! Well, it took me a long time to figure things out but I finally realised my default self-talk and body response had changed. I’ve attached a ‘worksheet’ that outlines a 3 step approach (click here to download). Maybe you can add some phrases in your own words? I can say with some confidence that it will take exactly as long as it takes to feel the change. No more, no less. And I am with you in your journey.

Personally, practising body awareness went hand in hand with letting go into self-compassion, so I’ve attached a worksheet for this too (click here to download) - but there’s loads of really great stuff freely available. Look for mindfulness, relaxation, body scans etc. as apps, courses, colouring books …

About wanting to lose weight, and acceptance … the explanation you’ve given is one way of looking at things. I often hear ‘acceptance’ used as meaning ‘being happy with how things are and not wanting things to change’. The way I see it, acceptance means recognising my reality and accepting it for what it is -without judging myself for the reality of my thoughts, my body, my needs etc. 

The acceptance is that I am  fully accepting of my reality. In the above  scenario this means:

1. I accept I want to be accepting. And I am ok.  
2. I accept I want to lose weight. And I am ok.
3. I accept I feel ambivalent. I am ok.
(4. Perhaps - I accept this makes me feel daft, confused .... I am ok.)  What I try and do is notice notice notice when the thoughts come in. This gives them a soft landing where I can let go of the struggle. It’s ok to feel your feelings. It’s ok to have your thoughts.  

Just a reminder, whether you ever feel you crack acceptance, whether want to lose weight or not, you are ok. 

I hope you can go gently, 

In Peace

Lucy

 

Rate, Share, & Inspire

Thank you for joining me this week on the Every Body podcast. If you enjoyed this week’s episode, head over to iTunes, subscribe to the show and leave a review to help us spread the word to Every Body! 

 

Don’t forget to visit our website, follow us on FacebookTwitter, and Instagram, and join our mailing list so you never miss an episode!   

 

Daria Matza