You would think that teaching nutrition would be easy. It’s something that our students have been doing since birth and yet, as with all topics that we teach in health, there is so much to consider if we want our lessons to be valuable and inclusive. This week’s blog post considers just that and comes from Drew Miller, an outstanding sexuality and health educator who you may have seen present at a recent NYSAHPERD conference.

One of the first lessons in my health education curriculum every semester involves going over the dimensions of wellness.  I ask my students to bring in a picture of someone they consider to be “healthy”, and the only instructions I give them is that it has to be a real person (not a cartoon character or a puppy, even though puppies are so cute).  The next day, students bring in their photos, and we tape them around the room, and we do a gallery walk where I pose the following questions:

• What trends do you notice among the photos?
• What do our pictures say about what “healthy” is?
• Where do our ideas about what “healthy” is come from?

Celebrities and professional athletes make up probably 75-80% of the photos, with the remaining photos made up of family members and friends (yay), or even people that come up under a Google search for “healthy person” (eye roll). As health educators, what do you think students say? Probably very similar things to what your students are saying.  But first, let’s talk about the photos they bring in. According to our pictures, “healthy” to them is:

• thin
• beautiful
• wealthy
• able-bodied
• primarily white (unless you’re an athlete) 

After a discussion that takes the entire class, we FINALLY get to the point that health is not just the visible.  You see someone’s physical appearance, but that is not enough to determine how healthy someone is. While this concept may seem elementary to us, it is a concept that is referenced throughout the semester.

• Does thinness equate to health? Sometimes, not always.  There are healthy and unhealthy people of every size and shape.
• Does beauty equate to health? No. 
• Does wealth equate to health? It makes it easier to access health services and information which can enhance health.  
• Able-bodied? You may have a condition that makes movement challenging, but that is one dimension out of many, and individuals with disabilities can still be healthy (I use the 10 dimensions of wellness as outlined by Dr. Sarah Benes and Holly Alperin).  
• White? Especially in NYC where I teach, low income communities of color do suffer health disparities at a disproportionate rate than their white counterparts.  

Each of these bullet points bring up a semester’s worth of discussion points.  Health is intersectional, and not one part of our identity encapsulates us, but I want to focus on the first part of the students thoughts: health is thin.  From a young age, we are all taught that thin is good. Thinness equates to health. Thin is beautiful. If you’re not thin, you need to shrink yourself through diet and exercise to be thin, so that you can gain the privileges our society holds for this group of people.  I think it’s important to acknowledge my own thin privilege while writing this piece. I’ve never experienced discrimation based on my weight, I’ve always been told I’m healthy, or that I’m in good shape simply because of my genetics. I also want to acknowledge that I am not a registered dietician.  I’m a health educator with a masters degree in sexuality education, so my yelling (or writing) should not be taken as medical advice.

As educators, we constantly hammer our students with the message that health is more than just our physical appearance and how we look, but are we really backing up what we’re saying with how we’re teaching health education, and also our daily practices? In our society, weight stigma is pervasive and destructive.  Weight stigma in our society looks like the following: 

• Students snickering at their fat PE teacher and debating whether or not he is qualified to teach.
• The message that fat people are lazy or lack willpower to be thin.
• Larger passengers on an airplane being forced to purchase two seats because they do not fit a standard seat.
• The consistent depiction of fat people in media as the funny, goofy, or sloppy friend.

Being fat is seen as a negative.  It is automatically assumed to be “unhealthy”, and something that must change.  There is no conversation that the problem is not a person’s weight, but the weight stigma and fat phobia that these people are receiving daily, much of which is embedded deeply in American culture. Instead of food policing and fat shaming, what about inclusion and acceptance? 

Here are some facts, strategies, and ideas that you can use to make your classroom and curriculum more inclusive for students of all sizes.  

• Health at Every Size (HAES)

If you haven’t heard about the HAES movement, it’s time to dig in.  It focuses on what we are talking about–health is more than just a number on the scale.  In fact, a growing amount of research is showing or at least trying to show that the stigma people of high weight experience for being fat may be worse than the physical harms of being fat.  It means what it says: you can be healthy at any size. It also discusses eating in a flexible manner (emphasis on pleasure and hunger cues) and finding ways of movement that one enjoys.

• Your nutrition curriculum should emphasize rejecting diet culture.

Study after study point to the fact that diets with the sole purpose of losing weight do not work long term.  You may lose weight temporarily, but a majority of the time the weight comes back plus more. We don’t trust our bodies, and feel like we can beat those cravings and urges, when in reality these are things our body does to help us stay alive.  We also need to help our students understand that even if they may not be on a diet, they are immersed in diet culture. I recommend this piece written by Christy Harrison, RD,  which outlines what diet culture is.  Most importantly, we need to reject the mentality that everyone can and should be thin.  Let’s celebrate all bodies and also acknowledge that for the most part, thinness is out of our control.  Genetics play a larger part in our size than diet and exercise ever will.  

• Stop praising weight loss, or even focusing on weight.  

Every time you tell someone they look great for the weight they lost, youre saying “you look better now than you did before”.  What was wrong with them before? We do this in our personal lives, and it’s harmful. Our students internalize these messages.  Instead of focusing on someone’s appearance, “Hey, you look great! Have you been working out?” try a “You seem so energized today! How have you been?”.  Our culture also does this with before and after photos. “I was fat (bad), but now I’m thin (good)”. People post these photos for validation, and the only thing it does is reinforce the fact that we feel we need to be thin to be accepted in society.  Find other ways to affirm your friends than complimenting their weight.  

• Watch your words.  As educators and humans, we need to watch what we’re saying around food and eating.  How many times have you heard someone say, “I shouldn’t have any more, I’ve already eaten too much” or the “no carbs for me, I’m watching my figure”.  Carbs are not bad, you should be able to eat guilt-free, and there is no such thing as clean-eating. As with anything in health, your words matter. Here is an article that lists 10 things you can avoid saying.  You’ll notice a lot of these phrases being thrown around during holiday meals.

• Focus on teaching your students to develop a positive relationship with food, rather than “good food, bad food”. I actually heard an educator at a conference this past weekend say that they don’t need breakfast because they “don’t need the “extra” calories”.  AH! This makes me so sad, not only that this human is restricting themselves, but because their students are likely picking up similar messages from this teacher.  We never want our students to skip meals, starve themselves, or restrict.  We want them to have a positive relationship with food, to enjoy the socialization aspect from eating in groups, and to eat intuitively, rather than to fit society’s unrealistic standards of body weight.  The problem is tied to food morality. Our society says certain foods are “good”, and certain foods are “bad”, which is bogus. Sugar, fat, salt, and calories are not bad. They are needed to live. As health educators, a lot of times we think we are helping when we give students healthy foods to eat, but we end up food shaming, which is not okay.  I would also beware of teaching students to count calories. Is it important for them to understand what calories are and how they work? Yes. Should they be counting their calories? Absolutely not. In fact, doing activities that require them to count calories could be triggering for students with eating disorders.

• Educate yourself.  Be aware of what’s going on in this field of research, and stay updated! I get a lot of my info from twitter and instagram, which leads me down different paths into studies, research, and literature.  Here are a few of my favorite people to gather information from. They are therapists, dietitians, and scientists:

1. 1. Christy Harrison: @chr1styharrison (twitter)
   2. Sonalee Rashatwar: @thefatsextherapist (Instagram)
   3. Alexis Conason: @theantidietplan (twitter)

This article is not meant to shame health educators, because we’re all doing the best we can with what we know.  However, we need to be constantly reflecting and striving to improve our practice, and a lot of what we’re doing now is not good enough.  If we mean what we say when we talk about health being multidimensional, we need to stop putting so much of our focus solely in the physical domain.  I could go on and on about diet culture and how toxic it is, but it is not going anywhere. As with anything in health, helping students to analyze the influences of diet culture in their lives is a first step in the right direction, but there is more work to be done.  We as educators need to take a step back and analyze how diet culture has affected our personal values about health and wellness, and also informed the way we teach our students. If you’re new to some of these ideas or want more clarification on some things discussed, check out the links below.  And remember, “there’s not a thin person inside you trying to get out”, and the sooner we start acting and teaching this way, the better.

Resources:

https://highline.huffingtonpost.com/articles/en/everything-you-know-about-obesity-is-wrong/

https://www.nationaleatingdisorders.org/blog/recognizing-and-resisting-diet-culture

https://christyharrison.com/blog/what-is-diet-culture

http://www.naafa.org

https://www.sizediversityandhealth.org

https://haescurriculum.com/

https://bmcmedicine.biomedcentral.com/articles/10.1186/s12916-018-1116-5

If you liked this blog post then you should also check out the following:

What We Don’t Talk About When We Talk About Fat by Aubrey Gordon.

Dimensions of Wellness – which includes an awesome free downloadable activity.

This Is Not Your Parents’ Health Class – health class is changing, for the better, and here’s how.