Delivering Weight Shame or Delivering Proper Care?

To kick off the one month countdown to the 2015 BEDA Conference we share a post from Oliver-Pyatt Centers Founder and Executive Medical Director Wendy Oliver-Pyatt, MD, FAED, CEDS on delivering proper care and buffering from the harmful effects and many times unintentional weight shaming. 

John Bradshaw said in his powerful book Healing the Shame That Binds You, “Shame is often cited as the buried emotion in all forms of eating disorders, compulsive eating and substance abuse.” I could not agree more! This about sums it up! That is why it is so exciting that we have Weight Stigma Awareness Week and why I am so happy to write on the subject of weight stigma and healthcare.

We, BEDA, created tool kits for patients to talk to physicians and for physicians to talk with patients. And I hope the tools are useful. I think this year, it is time for us to think further about the origins of shame, what makes interventions useful or not, and to think more about commonalities among all humans beings that lead us from what Bradshaw calls “Healthy Shame” to internalized, “Unhealthy Shame” – shame which is more difficult to escape.

Healthy shame is a temporary state in response to specific actions we may have taken (and maybe should not have). Healthy shame contains us, reminds us that we are not perfect, and mitigates us away from self-centeredness and grandiosity. It may not feel good, but it keeps us in check. I think of the kids who play basketball with our school team; there are those who may tend to shoot and shoot and shoot in the game and tend to not look to past the ball to their open teammate. My husband, “the coach,” with one disturbingly stern and upset look is able to induce a temporary moment of shame in the overly zealous shooter, which hopefully will allow better choices in the upcoming moments of the game – healthy shame.

But what about unhealthy shame? Unhealthy shame is a state of existence that intrudes into our identity, sense of self worth, and ability to feel connected to others. And this is what we really want to avoid, because this non-stop state of shame is what drives eating disorders, compulsive eating and addiction.

I was giving a talk at a university on Friday, and to drive home the point that we all experience shame, and the difference between healthy and unhealthy shame, I asked all participants to write on a piece of paper something they are ashamed about, crumble it up, and put it into a box so that I could (anonymously) share with the group. Here are some of the responses:

“I have herpes”

“Financial problems”

“I spend to much time tweezing my chin hair”

“I feel shame about my disorganization and procrastination”

And then, as I was un-crumpling the paper, I stumbled onto this one:
“I sometimes still feel like the poor, unclean, fat, insignificant, person I felt like as a child.”

When we completed this exercise, we noticed as a whole, how quiet the room became, and how we all felt closer when hearing these accounts of shame. We were humans among humans, all recognizing our collective perfect imperfections. In the first four accounts of shame that were read, it was clear that the shame was not a permanent state, it was an aspect of the participant’s life or themselves that bothered them. It did not completely define them. The participant did not write “I am herpes.” The participant wrote “I have herpes.” The crumbled up paper did not say, “I am disorganization and procrastination” it said “I feel shame about my disorganization and procrastination.”

If we want to make the delivery of healthcare something that is actually helpful and healthful, we have to be mindful of what we are delivering. Are we delivering a message that what you are is wrong, bad, and inadequate? Are we delivering shame? For those who are vulnerable, who have heard the message “eat less and exercise more, weight loss is good at any cost, fat is bad” throughout their lives in a healthcare setting, this non-stop messaging can easily create a state of internalized, unhealthy shame.

It is sad the person in the last quote still sometimes feels like an unclean, insignificant person. However, it is good news the person said, “I sometimes still feel this way” rather than “I am an unclean, insignificant person.” There was probably a lot of suffering and therapeutic work behind the person going from the more permanent state of shame he/she described to “still sometimes feeling” this way.

We really must live by the rule of first doing no harm. Einstein said, “We cannot solve problems by using the same kind of thinking we used when we created them.”

Healthcare practitioners must be mindful of the impact of unhealthy shame in every interaction with their patients. And patients must be aware of the impact of what I call “unhelpful help” – when well-intentioned, but uninformed healthcare providers use words and actions that are prone to inducing unnecessary and unhealthy shame.

It is okay, and it is even advised, to let out a gentle but powerful roar, and not allow the words or actions of others cause harm to ourselves or others.

This post was originally published on the BEDA website as an educational piece in support of Weight Stigma Awareness Week 2014 and the National BEDA Conference. To register for the 2015 BEDA Conference, please visit the registration page here.