Delivering Weight Shame or Delivering Proper Care?

Dr. Wendy Oliver-Pyatt is the Founder, Executive Director, Psychiatrist of Oliver-Pyatt Centers in South Miami, FL. She co-authored the Academy for Eating Disorder’s Guidelines for Obesity Prevention Programs. Her book, Fed Up! The Breakthrough Ten Step No Diet Fitness Plan, written to prevent dieting and disordered eating, has been featured in a variety of national publications, including Family Circle, Psychology Today, Women’s Health and Fitness, and Town and Country, and has been reviewed in the AED Forum, published by the Academy for Eating Disorders. She has given frequent presentations and interviews throughout the country and at national and international eating disorder conferences, and has been featured on WebMD. Dr. Oliver-Pyatt is a Fellow of the Academy for Eating Disorder (served as the Advocacy Co-Chair), is an active member of the National Eating Disorders Association, and serves on the Board of Directors of the International Association of Eating Disorder Professionals and the Binge Eating Disorder Association. Dr. Oliver-Pyatt kicks off #WSAW2014 with the following post featured on BEDA’s website


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 2014, 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. This year, it is time for us to think further about the origins of shame, and 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 tend to repeatedly shoot in the game and not look to pass 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 allows for better choices in the upcoming moments of the game.

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. This is what we really want to avoid, because this non-stop state of shame is what drives eating disorders, compulsive eating, and addiction.

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

“I have herpes”

“Financial problems”

“I spend too 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.”

While completing this exercise, we noticed as a whole how much quieter 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 crumpled 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 messages “eat less, exercise more, weight loss is good at any cost, fat is bad” throughout their life, in a healthcare setting, this non-stop messaging can easily create a state of internalized, unhealthy shame.

It is sad that the person in the last quote still sometimes feels like an unclean, insignificant person. However, it is good news that the person said, “I sometimes still feel this way” rather than “I AM an unclean insignificant person.” Most likely, there was 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 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.

For more information about Oliver-Pyatt Centers and Embrace, a Binge Eating Recovery program at Oliver-Pyatt Centers, please call 866.511.4325 or email admissionssubscribe to our blog, visit our website, and connect with us on Facebook, LinkedIn, Twitter, and Instagram