You're listening to Food is Food, the podcast that will support you to ditch diet culture, break free from food rules, and debunk nutrition misinformation. I'm your host, Talia Chiquelli, specialist eating disorder dietitian and founder of the TC Nutrition Clinic. If you would like to learn more about our one-to-one nutrition support and group program, or download your free portioning guide, head to www.taliacheli.com. Each week we will cover topics that delve deeper into nutrition, intuitive eating, psychology, diet culture, and the consequences of under-eating. Our relationship with food is so complex and it's influenced by our thoughts, emotions, and life experiences. Which is why healing from disordered eating is about more than just food. Welcome back to Food Is Food. It's a pleasure to welcome Glenn Macintosh on the podcast today. Glenn is an Aussie psychologist who is extremely passionate about eating, physical activity, body image, and weight. He is the clinical director of the Weight Management Psychology Clinic, the creator of the Transformation Support Community Online Program, and the author of the best-selling book Thin Sanity, Seven Steps to Transform Your Mindset and Say Goodbye to Dieting Forever. He also enjoys supporting the health conscious public and training the wonderful health professionals who support them. Welcome to Food Is Food, Glenn.
SPEAKER_01Thank you so much for having me.
SPEAKER_00We last were in contact, I think it was about ten years ago, we both attended a conference and you were were speaking on the panel, the Business and Health Conference in Brisbane.
SPEAKER_01Ah, yeah, Tara Diversity's conference.
SPEAKER_00Yes, yes. And I think, if my memory serves me correctly, we were at the pub afterwards, and I told you that I was thinking about moving to the UK.
SPEAKER_01I do remember. Yep.
SPEAKER_00Yes.
SPEAKER_01And then because then when you bring it out to me, I was like, oh, we've already made the move.
SPEAKER_00Yes, exactly. Yeah. You were like, give me a call. I'm like, I can't, I'm in London. Yeah. Yes. Yeah, it's amazing how quickly time goes.
SPEAKER_01Isn't it?
unknownYeah.
SPEAKER_01Isn't it? I've got a young gentleman coming back to see me in the clinic today. And uh it's been, we counted, it's been 10 years since I saw him last.
SPEAKER_00Wow.
SPEAKER_01And he was an adolescent at the time. So now I think he was maybe 14, and now he's about probably about 24. So you think, whoa. But to me, I'm like, if you had asked me to check my notes, I would have said, oh yeah, five or six years.
SPEAKER_00Yes. Absolutely. Gosh, that's wild. So thank you. It's been so nice to stay in connection with you and to have you on the podcast today.
SPEAKER_01Yeah, totally. It's great to be here.
SPEAKER_00Glenn, today I'd really like to share with the listeners and the community really having a discussion around BMI, weight stigma, what body image is. I think that's just going to be so helpful for everyone along the spectrum of disordered eating, eating disorders, and covering sort of people living in any shape or body size.
SPEAKER_02Yep.
SPEAKER_00So I thought to start with do a little bit of myth busting around BMI. So maybe let's just start the discussion on what is BMI, and we can talk about the BMI categories and how you and I would approach them in the work that we do.
SPEAKER_01Yes. Well, I think it'd be interesting to hear your opinion. My guess is that our opinions are probably pretty similar. And I think increasingly so, probably the opinion of a lot of health professionals is that we were talking briefly before about the origins of the BMI. And James Jacques Adolphy Quertelette, excuse us for any French people, we're probably I'm probably butchering that. But he was really like, if you look at his background, he studied mathematics, he studied astronomy, he wasn't a health professional, and then moved into epidemiology. So Quartelet himself had said the BMI was designed as a population measure, and it was never designed to be an individual of a measure's health. So I often talk about the BMI lie and that being the first lie that we're told. So whenever you are, like with you when you're with a health professional or whether you're just, you know, figuring out your own BMI and trying to use that as a measure for your own health and well-being, you're using in a way that wasn't designed. And so I call that BMI lie number one. I mean, I could talk all day about it.
SPEAKER_00Yeah, I was like, what's BMI line number two?
SPEAKER_01Let me remember. I wrote about this in my book, and I'm thinking again, time flies. I have started to, I don't know whether I should admit this to the public, but it's good to be authentic, I've started to forget little bits of my own book. It's been five years now. BMI Line number two, this is good, you're testing the front outfit. It's about the BMI cutoffs. So originally, when the BMI cutoffs were developed, the normal weight range went from 20 to 27.8. So it was actually a higher range. And then I'm not quite sure of the date, but in the 90s, the BMI ranges got lowered to where to the ones that we have today, where the the sort of the quote unquote normal range is 20 to 24.9, and then you get the quote unquote overweight range, which is what 25 to 27. Then you get the overweight ranges, about obese ranges.
unknownYep.
SPEAKER_01And when we look at why those BMI cutoffs got lowered, they got lowered by a section of the World Health Organization that was called the International Obesity Task Force. It's a very proper sounding name. If you look into the funding of the International Obesity Task Force, it was mainly funded by pharmaceuticals and Roche pharmaceuticals who had Xenical and all the stat, which were the big weight loss drugs at the time. From memory, one of them at least was taken off the market because it gave people high risk of hard facts and strokes. So for me, this has been my line number two. That actually, if we, you know, we look at the changing of those categories, millions of people became overweight overnight due to the change of categories. And I would say this is for dodgy non-medical reasons for commercial benefit. You think, okay, those people all become potential new customers. This was actually in my book, The BMI Lies section, was the most controversial section. And there ended up being, which I absolutely hate, two sentences. The whole book is completely authentically my words, but two sentences in that book had to be moderated because of the implications of calling out drug companies. So I think it's really important when we're considering our own health. Obviously, BMI is a very commonly used tool to measure what we quote unquote should weigh. I think it's really um important to look at well, what are the sort of the historical and what are the economic factors that are shaping how health professionals are telling us what we shouldn't and shouldn't weigh. BMI number three comes from if we look at the longevity of people in the various weight categories, it doesn't actually match the sort of normal, overweight, obese categories. For example, as people get older, being in the overweight category, generally people in the overweight category live as long as people in the normal weight category. If you look at older people, there's some evidence that being in the overweight category versus the normal weight category is actually a bit protective of longevity.
SPEAKER_02Yeah.
SPEAKER_01And then I'm not saying that there isn't a relationship between weight and health. But then if we look at the increased rates of morbidity, mortality, as people go up the BMI into the obese categories, it's not that they don't exist, but I would say that they're grossly exaggerated.
SPEAKER_00Yeah. And I think with BMI, like if we go back to BMI lie number two, is that it's just so important for everyone to know that those BMI categories didn't shift because we suddenly had this worldwide research project that looked at people's health and body composition, and that's the reason for it shifting. It was literally an overnight change driven by the pharmaceutical did the pharmaceutical companies and I was like looking for another word there, but yeah.
SPEAKER_01And it it didn't match the evidence. Yeah. And there are certain countries that resisted it. From my understanding, it could be Canada, maybe one of them, and there might be one other one who just said, hey, this isn't evidence-based, we're not going to go with this in our national guidelines.
SPEAKER_02Yeah.
SPEAKER_01And at the time there was huge debate in the empirical journals around it. But it's a sad example, I think, of the debate in the empirical journals was happened after the decision has had been made, and that the guys with all the money tend to control lots of things.
SPEAKER_00Yes.
unknownYes.
SPEAKER_01And it was for me, it was a really, when I was writing that section of the book, it was a real eye-opener as to the power of the drug companies. Uh I wrote that section as I wrote the whole book very authentically, and then I was told by the publishers, Glenn, you really need to water this down. Then you need to soften your language, and then you need to provide this additional evidence, uh, which I did. And then there were still further revisions made to it. Now, a little sneaky thing that I did was when I wrote the audiobook, I realized the person recorded the audio engineer didn't um didn't know what I was reading. So I just put it all back in there. So hopefully.
SPEAKER_00So if you're listening, listen to the audiobook for the BMI Live chapter.
SPEAKER_01I might even, we could even link your guys, because I think I was so annoyed with not having my pure voice in the book that I think there's a section there. I'll see if I can link it to you guys where I actually share that section of the audiobook.
SPEAKER_00Yeah, that'd be great.
SPEAKER_01But it was, it was really, really quite telling to me that the publishing houses were not willing to sort of go up against the drug companies, even with real facts. Yeah.
SPEAKER_00It's really in the UK, the NHS, so our national health system advertises the healthy quotations. Healthy BMI range is 18 and a half to 25. However, in practice, you know, especially working in eating disorders, we use the the range that you reference, more that 20. Well, I usually just say a minimum of 20. I don't like giving an upper range when I'm working and talking about BMI. So I really try to move away from using BMI in the way that it has been used for so many years, and really try to place emphasis on the fact that humans exist in many, many different body shapes and sizes. However, what we see is that maybe at the extreme ends of BMI, so someone significantly under a healthy weight for them or significantly over a healthy weight for them, and key emphasis is on them as an individual, that's where we can see that that there's an impact in terms of their health. And why BMI is not a great marker is because it takes two bits of information weight and height. It says nothing else about a person in terms of their body composition, genetics, their nutrition status, their sleep, their stress, their exercise, all of these key pillars when we think about what makes someone improve their health outcomes.
unknownYeah.
SPEAKER_00And then I think how BMI is used, especially in the UK, there's a lot of weight stigma present in healthcare. And I work with so many people that will go to a medical appointment and for no clinical reason they're asked for their weight to be taken. And then the discussion's more leaning towards them needing to change their body weight, even that has nothing to do with the session or appointment they were attending. And then we see the really stigmatizing labels that are put onto the current categories at the moment. And in your book, I loved how you created some other sort of labels or categories for the current ones that we use that were less stigmatizing.
SPEAKER_01Yeah, I think, yeah, I think that that's, I mean, I sort of do a couple of things in the book. It I sort of suggest that we first shift the ranges so they meet the evidence a little bit better. But then we sort of reframe the language around them rather than talking about a normal weight. You might use as it's sort of like a natural weight or a healthy weight. Rather than talking about an overweight person, you might say, if if that's medically the case, you might say we're above a healthy weight. And then rather than talking about the obese category, you could talk about even a person being well above a healthy weight. Also, I like the terms, you know, the sort of size-inclusive terms of someone who lives in a larger body. My mentor Rick Corseman, sort of one of the pioneers of the non-diet approach in Australia. So he's a GP by trade. And so it would call for the non-medicalization, the non-stigmatization of language, even in medical settings. And you know, some people will say living in a larger body or above a healthy weight is just like there's a lot of words in there, and he would always say, the extra words are worth it.
SPEAKER_00Yeah, I agree. And yeah.
SPEAKER_01Speaking of uh the health guidelines in the UK, I was at a conference on a panel maybe three or four years ago. And look, I wish I remember her name. She was fantastic. Uh she was a uh quote unquote obesity researcher, and she's actually in the UK and doing a lot of work to try and ensure that the the treatment of quote-unquote obesity in the UK matches the evidence, and then also trying to reduce the experience of weight stigma, and was talking about similar things to you talking about, which I found really, really heartening about using multifactorial measures of the person's health and well-being, not just viewing them as a sort of this height weight matrix and everything rests on that magic number, and doing a lot of things that I found quite heartening to hear. But then I did ask the question. Psychologist is always, you know, the person who might ask the random question, but I asked the question, I said, you know, when you're looking at the assessment of a person's weight and health and how you're then going to sort of report that back to the client, have you considered not using the terms overweight and the terms obesity? Because if you are trying to reduce stigma, a lot of people living in larger bodies find those terms highly stigmatizing. And unfortunately, the answer was no. It was no, this is a medical condition, we wouldn't go so far. Now, look, she did add an interesting nuance to this that I think is worthy of noting. She said, you know, Glenn, we talk about, you know, she's trying to reduce the stigma around obesity, but keep the label. And she did raise the point that we have done that for depression, anxiety. You know, it's more acceptable in today's societies for people to say, I have depression, anxiety, I struggle with mental health complications. My view is that how do I want to say this? That word is so deeply internalized as stigmatizing that I think it's a long bow to draw, that we see it in a non-stigmatizing way.
SPEAKER_00Yeah. There was a really interesting paper that came out of Italy that compared our current BMI categories to a cohort of people where they looked at their body composition and they used, and this is where I'm I'm not too sure where they sort of pulled the reference ranges for body composition. But basically what they did is they compared body composition and body fat percentage to current BMI categories, and they found that the BMI either over or under sort of diagnosed health. That we can help to create that holistic sort of view of what actually is health and how can we support people in a different way when they're going to their GP or medical appointments to not use BMI and to look at other outcome measures.
SPEAKER_01Yeah. And I think those other measures are actually really important. You know, we do a lot of work at the clinic. Obviously, everyone that comes to see us, they want to improve their health, they want to improve their well-being, they might want to improve their body image, their self-esteem, their relationship with food, all sorts of things. And I think it is important that, especially if we're talking about people who are, you know, motivated to improve their health, it is important, I think, for a lot of those people that we have measures of success. Because I think if we're to say, hey, don't worry about your weight so much, don't worry about your BMI so much, just focus on the way you feel, or just some of those things are like that's a good move, but some of those things are kind of amorphous. And it's like, well, how do I know if I feel better, or how do I know if I'm healthier? So in our goal setting approach that we actually call whole person goal setting because it assumes that the premise of it is that we are a whole person, and they're so complex and multifactorial that we can't be reduced to just one number, we do tend to shy away from setting obviously weight and body composition measures. But then we're really looking at, well, if they are not going to be our goalposts, what are some goalposts? And often I think that because we do live in such a weight-centric society, a society where we are told that thin is good and fat is bad, we're often looking to lose weight. And we sort of see that as like a sort of the gatekeeper to everything: health, happiness, success, good relationships. But often I think that a lot of us deep down know in reality that that's weight loss is not the gatekeeper of all of those things. So sometimes if you use better measures, and maybe what this study was kind of alluding to is that if we can use better measures, we actually can more directly target what we want. So if we want to say, for example, become fitter, let's not assume that being a certain weight or BMI is gonna be the gatekeeper to that. We can actually target that directly. And the same thing if we want to be healthier, that you know that could come from eating more nutritiously, which is gonna make us feel better and be healthier, regardless of what happens to our weight or shape or size.
SPEAKER_00Yeah.
SPEAKER_01So I think it's an important thing for people to look at in psychology. We call them the primary goals of weight loss. So it's like is the primary goals of what we expect weight loss will give us or the anticipated benefits of weight loss. And sometimes it's better to tackle those primary goals.
SPEAKER_02Yeah.
SPEAKER_01Even if it's something like body image. You know, often with Yeah, sorry.
SPEAKER_00Yeah, I was just gonna say actually, that's a great sort of lead-in to thinking about what is body image. I was just gonna ask, maybe it's helpful to think about that from a psychology perspective.
SPEAKER_01Yeah, I think it's incredibly helpful to think about, and especially when we're talking about BMI, because you know, when we're really what we're saying is with the BMI categories, is there is an implication of okayness or not okay-ness, depending on BMI. So we're outside the quote unquote normal range, we're gonna feel some experience of stigma. And so it's such a big impactor of our body image. And then our body image affects how we take the journey to greater health. So there are a lot of ways to define body image, but but my favorite one is to think about your body image being your relationship with your body. So, like any relationship, there are thoughts involved. Do you look great today? Or look at my just disgusting touch-up arms. You know, so there's thoughts, there's feelings. Is it a feeling of acceptance or a feeling of appreciation or a feeling of shame or guilt or embarrassment? And there's also actions. You know, any relationships involve actions, you know? And we're trying to think of one example of a million examples that come to my mind, but it's like the simplest way. Like, do I cook myself a meal or do I sit here and just eat a block of chocolate? So I think of body image being like your relationship with your body. And like any relationship, it has a whole, you know, it's a very complex multi-factorial thing. So we do a lot of work trying to encourage people to improve their relationship with their body. And sounds a bit corny, but care for themselves from a place of love. Because if we go back to the experience of weight stigma and body image concerns, I do think, you know, we always run the risk of when we talk about the uh the problems associated with BMI. And I think I've even done this if I am a little bit mindful in this conversation. It's easy to do of like bagging out health professionals. But I think health professionals are generally super caring, wonderful people. And sometimes what they're doing is they're inadvertently giving their clients and patients the experience of weight stigma. Clients are internalizing that themselves, and it actually the effects of weight stigma. So I'm not talking about the effects of living in a larger body, I'm talking about the effects of feeling too large to fit in with society, is the effects of weight stigma are absolutely catastrophic. So it has a huge toll on mental health. It's related to depression, it's related to anxiety, it's obviously related to eating disorders. We don't tend to commonly, sometimes we do, we don't tend to commonly see eating disorders without body image concerns. And if we look at, you know, even if we take the example of someone who does live in a larger body and wants to take better care of themselves, body image concerns are linked with the avoidance of exercise, especially in public. They're linked with both unhealthy overeating and unhealthy under-eating. So if you want to give yourself some abnormal eating, having body image concerns is a really good way to do it. And the other thing is that people who have a greater experience of weight stigma and body image concerns, they're less likely to see their health professionals. You know, because they're worried about, you know, being re-triggered or stigmatized or experiencing that weight discrimination. So I think if if there was anything we didn't want for someone who was wanting to take care of themselves, it would be to exercise less, to do either unhealthy dieting or overeating, to see their health professional less and to struggle with their mental health more. And that's why I always say you can't hate yourself healthy.
SPEAKER_02Yeah.
SPEAKER_01So we now approach that does sound a bit corny, but we talk about learning to love your body.
SPEAKER_00What are your views on I guess that concept of loving your body versus body acceptance or that sort of spectrum?
SPEAKER_01It's a great question because I have a like a clinical model that I call the body love model. And I think it's I really do mean a love of your body when I say it, but I think that we've got to be mindful of what those terms can mean. Because for a lot of people, I think, like, how could I love my body when I'm so far away from that? The goal can seem a bit lofty, and then you can start to feel stigmatized where it's like, oh my god, I'm living in this body and I should love it and I don't. And it's so I use the word love, so I should define what I mean by love. Just trying to figure out how I do this. Do you want me to explain it or do you want me to play a little game with you?
SPEAKER_00Ooh, um, play a game.
SPEAKER_01Let's play a game, and we'll play a game with everyone who's listening.
unknownYeah.
SPEAKER_00I'm nervous.
SPEAKER_01No, no, it's there's no need to be nervous because whatever answers come to you, that's the game. So there's no right or wrong answers. And it'll be interesting to like if you have like a channel or anyone, people can chat. Like, I know this is going on YouTube, so it'd be interesting for people to just put their first answers in, pause the video and just put their answers in. So, what I say is say that an alien came from outer space, and this alien had come to Earth to explore this strange phenomenon that we had that is called love. And then I want you to have a think about it and think, well, how would I describe love to an alien? What components make up love? What are the parts of love? If I love someone or if I love something, how do I treat it? And so, if you know an alien was to ask you that, what sort of things would come to your mind?
SPEAKER_00As you were speaking, my chest around my heart started to become warm. So for me, it's like a deep connection with someone was the first thought that I had.
SPEAKER_01Deep connection, yeah.
SPEAKER_00And then and then for me, the next thought was so deep connection and truly being able to be myself. And I guess I'm thinking more like the people that I love and love me in my life. I think it's about being true to myself, true to my values, them understanding me for who I am, and us having a deep sort of connection and trust based off that.
SPEAKER_01Yeah, so there's words like there's a feeling of a deep connection, there's a feeling of maybe uh authenticity or acceptance of who you are. It's like I can be myself, or people who I love, they can be themselves around me. And there's sort of an interesting word there that you use, which is trust. Yeah, thank you for playing that game. I'd love to. If you do have like a YouTube comment section, I'll I'll be keen to hear what people's instinctive reactions were. And I do this with clients too. So this can be like uh I know you have a lot of health professionals that listen to your show, so this can be a good little exercise to do with clients, and then I just asked them, well, what would happen if you treated your body by your own definition of love? So, you know, if people were to feel more authentically okay to be them, for people to feel more connected with their bodies, for people to feel more trusting of their bodies and more accepting of their bodies, what would happen? And I often just think about it in practical terms. Would you would you move your body more or less? Would you feed it more nutritiously or less nutritiously? When you are looking at yourself in the mirror, would you be more critical or would you be more accepting? What would you do more or less or differently if you were loving your body more by your definition of love? So for me, in the model that I have, the body love model has three bits, and you kind of you got pretty close to the way that I define it, which is I define body love as acceptance. So when we have love for someone, we tend to accept them. Doesn't mean we don't see the flaws, doesn't mean we like every bit about them, but we choose to accept the whole thing. Number two in the body love model is trust. You know, when we love someone, we tend to trust them. There's a trusting relationship. And so I think that is really important when it comes to your relationship with food, your relationship with movement. Do I listen to my body's signals of when it's hungry, when it's full? What type of foods, you know, does it like and does it not like so much? And also our relationship with movement. Do I trust that my body can do the things that I want it to do? And the third element in my body love model is care. So, you know, we care for people that we love. So, you know, caring for your body again doesn't always mean that you feel like doing it. You know, I think there's a beautiful act of love and care that a lot of people, I know a lot of your clients and a lot of your listeners are recovering from eating disorders. And I think there's a huge amount of care that comes from re-feeding yourself and nourishing your body that's not always easy, that's actually really, really difficult. And so I think when we love something, we tend to care for it, yeah, when it's easy and when it's fun, but also care for it when it's really hard to care for it.
SPEAKER_00Yeah.
unknownYes.
SPEAKER_01I love that activity. It's a really good activity, and it starts to because if body love can sound really cheesy, and it can if we don't explore what it means. And look, it's just a word, so this is what it means in my model.
SPEAKER_02Yeah.
SPEAKER_01But it it can also seem too lofty a goal, and then it can kind of turn you off that approach. But I think sometimes when we look at it as uh loving ourselves by our own definition of love, and then what does that look like practically in my behaviors? Or we think of it about uh, you know, I talk about it as acceptance and trust and care and cultivating those, not perfectly, but just moving towards greater acceptance and trust and care. Then it tends to be something people go, yeah, I I could see myself doing that. I'd like that.
SPEAKER_00And this is where like it's surprising, but it's not surprising. Often I'll have people come to see me and come into the clinic who are in larger bodies, and their first thought is, well, I need to see a dietitian because it has to be about my nutrition. And they're often so surprised when I refer them to a psychologist for this exact reason, this beautiful activity that you just did. There is, I can't tell you the shift that people make when they have that multidisciplinary approach. But I think society tells us that to be in a smaller body, it's just about the nutrition, or to be healthier, it's just about nutrition and movement. When our mind and our beliefs, our values are just so important in healthcare. And it really is like the missing piece for a lot of people's journeys for a better word.
SPEAKER_01Yeah, I completely agree. I call it like the missing piece of the puzzle. And I think it's a funny one because for a lot of us, it is the missing bit. Like if we want to take better care of ourselves, if we want to get healthier, it kind of makes sense to us to go and see a doctor. It kind of makes sense to go and see some type of exercise professional, an ex-fears, a PT, someone like a dance teacher, whoever it is. It it kind of makes sense to see a dietitian, and then I think the psychologist says, you know, I've been advocating for this, but this is my 20th year of practice now. So I've been advocating for this for 20 years. It's like, it might not be our first port of call to say, I want to see a psychologist. Uh I think that's slowly changing. So I often think that, you know, all of the bits are really, really important. Uh, I always say taking care of yourself is a team sport, you know, from a professional's point of view. It's it's really takes every one of that team and more that you need. But I think it's a real missing bit for a lot of people. And I think it can help to unlock some of the other bits. We get a lot of people that come to us from doctors and dietitians like yourself who will, I think, and I'll put you in this category, Talia, as you know, really great dietitians, they have a real awareness of the psychology. And I think really great dietitians, uh, as well as doctors and personal trainers, they do a whole lot of psychology in their sessions.
SPEAKER_02Yeah.
SPEAKER_01But then I think there sort of comes a point where it's like, actually, you know what, the challenges here are really mainly the domain of the mind. And what we find is that that often, say, if somebody's seeing a dietitian, for example, and they might be knowing, it is going to be good for me to eat more, or it is going to be good for me to eat less. A lot of what a good psychologist can do is help you to bridge that gap between what you know you want to do, what you've collaborated with your nutrition professional on, and actually doing that. Because for me, that barrier, that gap between intention and action, most of that can be resolved by psychology. It's like, why don't I do that thing that I want to do? Or why do I keep doing that thing that I don't want to do? And the answer is so often in your mind. That's why I think it's the missing bit.
SPEAKER_00I couldn't agree more. And that's usually one of the signs for me as a dietitian when I notice that if I am just working with someone solely, they'll get to a point that they get stuck and they can't follow through with what we're discussing. And that to me, as soon as that happens, I'm like, let's consider getting a psychologist on board.
SPEAKER_01Which is the perfect time. Yep. And psychologists can kind of offer sometimes some very simple techniques that can help bridge that gap between knowledge and action, psychological skills and things like that. Or sometimes help you explore deeper the the why is it, what is actually going on underneath here that's causing me to have this challenge and this gap between what I want to do and what I'm regularly doing. Yeah.
SPEAKER_00Yeah. One of the points you made earlier, Glenn, was around health professionals and how we can sometimes inadvertently sort of add to the mate stigma sort of experience of the people that we're supporting. And it just made me think about how I'm hoping that it's changed, but I think that to people like myself who were in uni almost sort of 15 years ago, is that we were very much taught and it was embedded to use BMI categories in the unhelpful way. And conversations around weight bias and weight stigma, like they're not terms that I even knew when I was at university.
SPEAKER_02Yeah.
SPEAKER_00And I just thought it might be helpful to talk a little bit about weight bias and what that is and how that might show up in both health professionals and just as humans.
SPEAKER_01Yeah, yeah, that's a great question. And so weight bias, I think it's really, you know, it's better. Sometimes we can get a bit technical about these terms, but there's prejudices, you know, based on someone's weight. And if we look at weight bias basically, we can think of that we live in a society that idealizes thinness and stigmatizes fatness. So the bias is that thin is good, fat is bad. And so we tend to look at the world through a weight-biased lens. Unfortunately, if we look at some of the research on our automatic associations with fatness, we do see that there are a lot of varieties of bad that it's associated with. We are more likely to believe, whether we consciously acknowledge it or we don't, we're more likely to believe that fat people are bad. We're more likely to believe that they're stupid versus smart if we do word associations, and we're more likely to believe that they're lazy versus motivated. So when we talk about weight bias, we're talking about that, just like we would talk about any other type of bias. We're talking about those preconceptions that we have, sometimes consciously and other times unconsciously. And I think it's really good in this discussion to talk about the weight bias of health professionals, because I think we all are trained in a weight-centric, weight-biased way to a degree. And I think that we've sort of talked about that if we're sort of, you know, trying to get somebody to be somewhere and they're acceptable if they're there, but they're not. And so we're trying to get them to be from being some version of bad to some version of okay or good. As I think that our training doesn't do us any services there. We've got to almost undo or train ourselves. Yep. And I think you raise a really good point too, because health professionals, we might get a double dose of that weight bias because we're trained in a weight-biased way. But even just the person coming in to see a health professional, you are going to have your own weight biases because of society. You are swimming in the same pond of thin sanity as I call it.
SPEAKER_00The title of Glenn's book, by the way. The title of my book, yeah, good one.
SPEAKER_01Thank you. Yeah. Yeah. So, you know, we're all swimming in that same ocean of thin sanity. And I think that's really important to realize because not only do we health professionals have tend to have unconscious biases, our clients tend to have unconscious biases. So the way that I deal with that in therapy, and the way that even if you're on your own journey of change that you might want to deal with that, is I talk about weight bias being, say, if it's in a health professional session, being the third person in the room. So there's you, the client, there's me the therapist, or the dietitian, or the trainer, or the doctor, and then there's the weight bias. Often the weight bias is happening on less conscious levels. So we've got to be aware of it. And so I think being aware of it brings it from the unconscious into the conscious. So now it's something that we can work with. And what weight bias is going to tell us in our sessions is that myself and my client are probably going to want to find a way to try and justify making the person thinner, whether that makes sense or not. So I think the thing to do is, and this is where I talk about being the third person in the room, is not to say that you definitely do need to lose weight, not to say you definitely don't need to lose weight, or not to say you do need to gain weight, or you don't need to gain weight, but let's assume that you and I are automatically going to think that you need to lose weight. And let's be aware of that assumption. So then it's out open in the room, and we can explore whether that fits or not in your scenario. So you're actually doing a conscious awareness of the weight bias that you probably have, that your health professional probably has, and just being aware that it's going to want to influence your decisions. And you can collaborate on a weight bias treatment approach. And when you're aware of it, to try not to make the choices in line with that weight bias. I think it's really important to understand that, you know, to really differentiate the difference between conscious understanding and unconscious understanding. So in my workshops, which I do with health professionals, in my book, I have an implicit associations test, which is a reaction time test of weight bias. And what it does is it measures your unconscious bias. Because I think most, and I'll use the word that comes from my mind, most good people don't think that fat people are bad and all thin people are good. At the same time, when we research our weight bias and when we explore our own weight bias through the implicit associations tests and word pairings, it does show that most of us do hold unconscious biases. And so that's not to, I suppose, when I teach this with to health professionals, not to believe that we're terrible people. No, we're often really loving, caring people. We want to help people, but it's not until we can acknowledge our unconscious biases that we can then transcend them. And in my experience, it actually tends to be a very conscious thing. So I remember doing similar tests of weight bias with people like Rick Corsman with Lindo Bacon and some of the Australian sort of health and every size sort of gurus. And what we found was that typically their weight bias reduced as they practiced in their area more from a sort of a non-dieting body neutral perspective, but it didn't approach, it didn't get close to zero. And so I think that's interesting for us all to note that those unconscious, internalized assumptions will still exist. So we need to be consciously aware of them.
SPEAKER_00Yeah, it's so important. I actually did one of those tests recently, and it did come up that I had some internalized weight bias, which didn't surprise me just because I'm aware of how I was bought up and you know, diet culture and all of these things. But it was good to do because it made me stop and reflect, and it meant that I'm, you know, since doing it a few weeks ago, that I'm more aware. So I would encourage people to do a test or similar. And you also have some amazing resources on your website. I don't know if there's anything specifically about that, but I know there are a bunch of different resources available.
SPEAKER_01Yeah, we do have some great resources on there. I'm just trying to think of the implicit associations test and some way that we could get it to your guys. Let me have a think about it, because there is a section in my book about it, and what I'm wondering is whether I could just like link you to a PDF of it and you could do the test, but just depends on how big that section of the book is because you might have to read half the book because I think I set set it up a little bit of time. But we'll figure that out. Otherwise, there is a link, you can actually do it electronically as well. So I might be able to get that link.
SPEAKER_00Yeah, that would be amazing.
SPEAKER_01Yeah, and it is it it's quite confronting when we do it. I call the section in my book uh, do I hate fat people?
SPEAKER_02Yeah.
SPEAKER_01And it's like, well, it obviously the instinctive conscious answer is no. But and it's a bit of a provocative sort of title for that, but it sort of does help us understand ourselves, and we might have this association of thin is good and fat is bad. And it's not until we can confront that that uncomfortable truth for most of us that we. Can then be empowered to transcend it.
SPEAKER_00Yeah. Yeah, it is, it is being vulnerable. It's vulnerable me to sharing that on here as well. It is. But I think it's really important to just have that open discussion.
SPEAKER_01I literally, I'm thinking of the slides I have when I present this material typically to dietitians. I've done it through dietitians Australia workshops, psychologists, and now I'm doing more and more work with GPs, which is great. We do the test, and my very next slide is sort of says something like, you are not a bad person. You know, because it's really confronting to think I have these assumptions. And actually, consciously and in my heart, I probably feel the exact opposite. I don't feel that way at all, but I've been trained by society. I think to come back to that ocean of thin sanity and the training that we have by society, both us as health professionals in our little spheres, but also by society, is that this is an ocean of thin sanity that we've all been swimming in, and it is absolutely not natural or necessary. You know, I often use the funny kind of analogy, but like we weren't like little babies in our diapers wondering, like, does my bum look big in this?
SPEAKER_02Yeah.
SPEAKER_01This is something that we've learned. And the good news is with a bit of work, mindfulness, vulnerability, we can unlearn.
SPEAKER_00Yeah. I often, one little activity that I might do with people that I work with is just even to, you know, I'll say, imagine if you're on an island, you know, for a couple of months and there's no mirrors on the island. How might you think that your relationship with your body will change over that time? Or imagine if all the clothes that we bought didn't have sizing tags, how might you view your body differently? So there's there's so many ways in which we're constantly sort of told that our bodies are not good enough in the size that they are and how we view how you're just these constant bombardment of messages to the point where it's normal to not like your body.
SPEAKER_01If you are comfortable in your own skin, if you feel like you look okay, if you know you're not obsessing over the way you appear all the time, you are actually abnormal in this day and age. So what we talk about in the clinic is we're trying to create a bunch of really random weirdo unicorns.
SPEAKER_00Yes. Yeah, it's the same with relationship with food. If you have an intuitive, natural sort of eating practices, that's far from the norm these days. And that's why it can be so hard for people to even grasp the concept of what normal eating might look like.
SPEAKER_01As you're talking about that, I just think that we've talked about the drug companies and the medicalization of the BMI. That's one thing that affects us. And then we have, you know, if you talk about the clothing sizes in terms of our body image, we have the fashion industry.
SPEAKER_02Yeah.
SPEAKER_01You know, what if the fashion industry is designed to sell us things? And it's the simplest, simplest marketing strategy ever. It's thin ideal image, so that creates immediate desire. That without it's a three-step process, thin ideal image, then that creates that experience of body image concerns, body dissatisfaction. But we've got the answer, you just buy the thing. And so it's a great marketing. So we do have to be aware, without getting too tin-foil hat about it, about these forces that are invested in us consistently trying to lose more weight, consistently trying to buy more things in order to feel better. And then when you talk about relationship with food, we've got like we're in the middle of a sandwich here. We've got the diet industry, the multi-billion dollar diet industry telling us to, you know, do their version of the diet, which is the only one that works with this hugely powerful marketing engine. And then we have the food industry that are getting us to sort of eat all of these hyper-palatable, high-energy, low nutrition foods, high-impulse low nutrition foods. And you think about what a great way to get out of touch with that natural, beautiful, amazing self-regulator that we have in the body. It's like no wonder our signals are all uh messed up, and our ability to listen to them's what it uh not what we want it to be.
SPEAKER_00Yeah, no wonder we're so disconnected.
SPEAKER_01Yeah.
SPEAKER_00And that comes back to trust, no wonder we can't trust our body.
SPEAKER_01100%.
SPEAKER_00100%. Um, so maybe just to end on Glenn, a fun fact about you is that you were the psychologist on the biggest loser in Australia for I think it was one season.
SPEAKER_01It was one season, yep.
SPEAKER_00One successful season. Um and I heard this on another podcast that you're on, that it was so interesting that firstly, amazing that you and the team that were part of that season decided to take a different angle or a different approach to help the contestants on the show. And then what I'd love for you to share about is the relationship between that approach and the view rate or quote unquote, like success of the series and what your experience of that was.
SPEAKER_01Yeah, yeah, yeah. It's so yeah, it was for me, it was a really big deal and a really considered decision to work on the biggest loser. And originally we got an invite to sort of audition for a particular show, and I'm like, what is this show? And I called them up, I'm like, this is not the biggest loser, is it? Um, because and I sort of said, because I think that show is I won't even say on the podcast, but I say it said to them on the phone. And they they said to the producer said, Look, we we don't have a name for the show, but we want you to to sort of audition for it. Like, okay. So the idea of the show was it was going to take some similar principles, like of the the biggest loser, but it was going to be a different show, and it was going to be different in that it would have a weight loss element to it, but the weight loss element would be much more balanced and much less extreme. They also wanted to treat the contestants differently, so in a less stigmatizing way. They wanted it to be less about, oh, look at these fat people and how extreme their lives have become and let's enjoy their struggles, to let's support them and let's see how people can positively change their lives. And in line with that, they sort of changed um the professionals supporting them. So basically, I think that probably we had the um Michelle Bridges, probably the commando was the most hardcore, and then Michelle Bridges, and then oh my goodness, I've forgotten the name of the other guy. He was the guy I ended up working with. Anyway, I can picture his face. And so Michelle Bridges and the commando left, and then they had Libby Babette, who's actually a friend of mine, for Libby. It was so funny. I said, Libby, you got the biggest loser gig. And she's like, Yeah, and I'm like, I applied for that gig too. And she's like, Yeah, I saw you on the list of people, and I was like, pick that guy. So I think she actually helped me get the job. And then there was me, so a psychologist and not a trainer who came on. So even the sort of the mentors of the people were a bit more balanced in their approach. Shannon Ponton, sorry, Shannon. Uh and then kind of what happened was I think the producers had a bit of a freak out and decided we can't call it by another name. So they ended up calling it the biggest loser transformed. So it was sort of just still the biggest loser, but it was supposed to be sort of a different version of it. And it was really, really interesting. I mean, I think I did have to make peace with the fact that even the more balanced version of the show, it's not something that I would have done with my clients. And it's not something I don't think that you would do with your clients. And it's still something we would really recommend to people. But I had to make peace with that and kind of, I suppose, negotiate hard for having what I believed were good messages that would be in the psychology sessions that we did, that would be good messages for the contestants and good messages for the public. And I think we definitely achieved that. Like the first session, the very first psychology session, we talked about, and it's right at the start of these contestants' journey, we talked about body image. And we talked about how body image is not as much about the external results and the number on the scales as it is in your mind. And you know, I'm thankful to the producers for being open to share some counterculture ideas within the show. So the whole show was, like I said, it's not something that I would have done with clients, but it was the most balanced, most accepting, most, and even the way the competitors, that the way they wanted to set up the competitors, they had the you know, one trainer's team, the other trainer's team. And they said in old teams they really wanted to make them enemies, but in this, they sort of looked at them more like a sibling rivalry. So they were still sort of like supporting each other, even though we're on different teams, and and I didn't even know whose team anyone was on. I'm like, I can't remember who's on whose. But it was really, really interesting because I remember talking to the head producer Margie Bashfield, and Margie's a really smart woman, she's master chef, she's the project here in Australia, smart, smart woman. And she was really excited about the program, and we just had a really good vibe. And you know, one of the cool things was even though it was really at heart still a weight loss show, the contestants were really open to these more balanced new ideas and the psychology, they were super open to it, which was really cool. And then I remember talking to Margie Bashfield the day of the first show, and I'm like, I think you know, I'm just so hopeful that Australia will really like this. And she's like, and apparently Australian audiences had called for this. Hey, we don't like seeing this crazy, stigmatizing stuff, you know, it's just too extreme. And Margie said to me, Well, now we get to see whether the Australian public wants what they asked for. And the interesting thing was, speaking to the producers afterwards about how the show went, they said, Well, we often have it's pretty simple. We have lots of bad comments come in and low ratings, or we don't have many bad comments come in and we have really high ratings. That's typically the late TV shows go, apparently. Yeah, but they said something really they said, this show is a really weird show because we're getting all of these really positive comments, like people riding in saying, This is fantastic, this is helpful for you know the viewership, this is much nicer, more nourishing, fulfilling TV. But the ratings were really low too, and it turns out that you know, all of that drama, all that stigma, all of those extremes were actually what people wanted to see.
SPEAKER_02Yeah.
SPEAKER_01So uh so we did one episode, and I sometimes half-joke that we killed the biggest loser.
SPEAKER_00Thank you, Glenn.
SPEAKER_01But I think that my experience of it was I was probably very guarded in what I said and really didn't want anything to be misconstrued. But to the producer's credit, they did create the show that they said they would create. And I think it was a better version. I'm not an absolutist, so I think that moving things in a certain direction, you know, and that's why I chose to be on the show versus not. I thought I could add what I hope and what I think is a positive influence, but it turns out that not many people wanted to watch it. Which I don't think is a bad thing.
SPEAKER_00No, yeah, it says a lot about our society, and I think it was really courageous for you to to go on and try to shift the approach because I completely appreciate that you might have had a bit of sort of backlash from within your your own sphere. But I think unless people take those steps, then we're not going to challenge these extreme ideals and views that we have about health. So I think it was a really important thing.
SPEAKER_01Well, thank you for saying that. And I appreciate it. And I was, you know, I did cover a bit of flack, which I totally understand. But I was actually also heartened by a lot of people who, in our sphere here in Australia, sort of said to even people in the non-diet body positive spaces sort of said, Hey Glenn, you're, you know, we've got your back. We we get it, and we have faith in you to represent maybe not our absolute ideals, but to give the public a taste of some of our ideas. So thanks for saying that. Because it was it was a big move.
SPEAKER_00Yeah, and I think like just to summarize, and you know, this is what we do in clinic you and I is we try to move away from those extremes because we know that's what works, that's what's sustainable. But in our society, we're looking for this quick fix and this extreme nutrition, extreme movement is what typically sells, but we know it just doesn't work, it's not realistic.
SPEAKER_01Yeah, yeah. And I think to add a real positive note in there, and I'm thinking about that gentleman who I'm coming back to see after all that time, he's done so well, and then he's come back in all keen as to support him with whatever is going on now. But that is the way life works. We are sold quick fixes, you do this and then you're dumb, and then that's it. And that is, as you know, and I think as all of us know, that's not really the way we change. And I'm very happy in the clinic. Like if someone wants to come and see me for six sessions and smash out one particular issue, I'm all in for that. But I've got clients who I've seen for four, five, six years, and the process is a you know, we all we often talk about in our online program, intra for our online program, is taking small, imperfect steps forward. And so it's nice to hear that from you and you know, let this be an advocate for anyone who's listening for slow change. And that's not we don't mean being lazy or doing nothing, but we mean just understanding that we are not robots and that sometimes even if we know exactly what we want to do with our nutrition, movement, sleep, stress, jobs, relationships, that gap between knowing and doing is there for a reason. And so to have a bit of compassion for ourselves and to work through that in, you know, in the time it takes, which we can't always determine what that is, but with the faith that we can get there.
SPEAKER_00Yeah, definitely. Well, thank you so much, Glenn, for joining today. I'll add your book, Thin Sanity, into the show notes and we'll add a couple of things that we shared. Please do go check out Glenn's website. He has amazing resources if you want to work with Glenn or his team. You are based in Australia. Do you support people through telehealth internationally, or is it just Australia-based?
SPEAKER_01We do. So we do, we're mainly Australia-based with the psychology clinic. We do have a small amount of people from other countries who do see us via telehealth, but it ends up being like it's done as counseling sessions, so we don't do any sort of rebates or that sort of stuff. So it's mainly the telehealth we do in Australia in the clinic, but we do also have an online program which sort of supports people more worldwide. And it is quite closely supported. So we do a live webinar every week, 48 weeks of the year, and we've got a sort of a member-only community with myself and other psychologists in there. So it's not one-on-one psychology, but it's very, very therapy-like.
SPEAKER_00Fantastic. Well, thank you so much again, Glenn, and I'll chat to you again soon.
SPEAKER_01Thank you so much, Tali. It's been a wonderful conversation. I love it.
SPEAKER_00Thank you for tuning in to Food Is Food. If you found the episode nourishing, hit subscribe so you don't miss our weekly episodes. And just before we wrap up, a little reminder that the discussions in each episode are for informational purposes and don't replace individualized advice. Because every recovery journey is so unique. Please consult your healthcare provider for support. That's all for today. Stay nourished and see you next time.