Food for Thought – Revealing the Shame and Weight Connection

What do food, weight, and shame have in common?  Well, more than enough to keep us talking for ninety minutes.  And then some.

In most circles, the mere mention of the word shame can stop a conversation dead in its tracks.  But when you’re hanging out with psychotherapists, it’s an entirely different story…

On the sunny Saturday of April 12th, I co-presented a workshop with Brook Damour—Food For Thought: An Exploration of Weight, Shame, and the Unconscious.   

As part of the Northwest Alliance for Psychoanalytic Study’s annual conference, Forum 2014, our presentation was designed to expand the conversation about food, weight, and shame.

I imagine that at this point you are wondering:

“What ever possessed her to spend a beautiful spring Saturday inside a conference center talking about shame when she could have been out in her garden or playing in the sunshine with her grandkids?”

Well, let me tell you.Discover More

Another Nail in the Low-fat Coffin

He walked out onto the stage to give his talk, all 6 foot 7 inches of him. I noticed that he didn’t stand behind the podium, but walked in front of it. No jacket, with his sleeves rolled up. I liked his more casual approach.

The title of his presentation was “Update From Sweden.” Sure it was exciting that Dr. Andreas Eenfeldt had come all the way to Philadelphia just to speak at the American Society of Bariatric Physicians spring obesity conference, but how different could things be in Sweden?

After a full day of hearing more evidence about the clinical benefits of low-carb eating for those who are overweight or obese, I didn’t expect anything revolutionary. But always eager to learn, I gave him my full attention.

Using a clever chart in the shape of a pound of butter, he showed that butter consumption in Sweden decreased by 232% from 1985 to 2005. Just like Americans, the Swedes had been told that low-fat, high carb eating is the healthiest, particularly for those who are overweight or have high cholesterol, heart disease, or type 2 diabetes.

The chart also showed that during this period, obesity went up substantially. Just like it did in the U.S.

Nothing I didn’t already know. Bad medical advice can cross oceans and be kept alive for decades anywhere.

A photo of a smiling Swedish woman wearing a white lab coat flashed up on the screen. Dr. Annika Dahlqvist was one of the first physicians in Sweden to prescribe low carb diets to her type 2 diabetes patients.

Her results were amazing, with person after person losing weight and improving diabetes, high cholesterol, high blood pressure, and a host of other chronic medical conditions.

No wonder she was smiling.

Despite these spectacular results, some dieticians reported her to Sweden’s National Board of Health for using a “fad diet” that veered from traditional practice. An official investigation was launched.

“Oh great,” I thought. “This is just what I needed to hear. Another doctor vilified for not following conventional practice, even if it’s not based on science.”

I went back to knitting my scarf, but continued to listen. I just couldn’t bear to see what was coming up next.

“After a thorough investigation, including an extensive review of the medical literature, the Swedish investigation committee concluded that…”

I looked up and there he was, hammer in one hand, big shiny nail in the other, poised to deliver his first blow.

“Low-carb diets can be seen as compatible with scientific evidence and best practice for weight reduction for patients with overweight or type 2 diabetes.”


“25% of Swedes now eat low-carb and obesity in Sweden is decreasing.”


“Sweden had a butter shortage in 2011.”


Now I get why Dr. Dahlqvist’s smile was so big.

For nearly a decade I have recommended low-carb diets to my overweight and obese patients and have had the same results as Dr. Dahlqvist: Weight loss and improvement of metabolic conditions such as type 2 diabetes, high blood pressure, high cholesterol, and numerous other chronic conditions.

Although the evidence wasn’t new to me, discovering that things had improved so dramatically for an entire country was BIG news to me.

And it gave me hope that our medical system will finally retire the harmful low-fat dogma that was never based on science and recommend evidence-based low-carb diets as treatment for overweight and obese persons.

The story continues…

The Swedish Council on Technology Assessment in Healthcare—an independent governmental agency—spent two years examining the evidence for low-carb diets.

In October 2013 they issued their report: Dietary Treatment for Obesity: A Systematic Review of the Literature.

They concluded that low-carb diets are more effective than low-fat diets for reducing weight, lowering glucose levels, and improving cardiovascular risk markers.

For more details about this report, check out Dr. Eenfeldt’s blog.


Do you think it’s time to lower the coffin into the ground?

Please visit my blog and tell me what you think.

If you’ve had success with eating low-carb, I’d like to hear about your experience.

Philadelphia Freedom

“Did you climb the Rocky Steps?”

“Yes! The view at the top was awesome.”

It was the most asked question after my return from Philadelphia last week, where I attended the spring conference of the American Society of Bariatric Physicians (ASBP).

Made famous in the 1976 movie Rocky, the Rocky Steps are the 72 stone steps that lead up to the entrance of the Philadelphia Museum of Art. Tourists flock to them, reliving the journey from underdog to victor. Stopping at times to indulge in the view, their perspective growing wider and grander with each step.

Although our conferences are held in some great cities, I am rarely able to partake of the local sights. My days are jam-packed with learning from early morning until early evening, leaving barely enough time for dinner, meetings, and sleep.

But I got lucky in Philadelphia.

With some free time before my flight back to Seattle, I was able to view the museum’s renowned art collection and scale the iconic steps. Each step reminded me of the power we have to overcome our limitations—both real and imagined.

I thought about the limited perspective that so many have about weight, about the misconceptions and the stigma. I remembered how my heart hurt when one of the conference speakers reminded us that the characteristic that is most discriminated against in our country is weight.

I recalled the stories I’ve heard from people seeking medical care who are met with simple answers, or blame and shame, or both, when what they really need is accurate information delivered with respect and sensitivity. I saw the faces of those who want to be seen as a person with a medical issue, not as someone who is defective. I thought about how infrequently this is the case.

And my heart hurt even more.

Then it occurred to me:

I am in Philadelphia—the birthplace of American freedom.

Home of the Liberty Bell. The place where the Constitution was signed. A major hub of the Underground Railroad.

It has always been a gathering place for forward thinking people who simply won’t accept the unacceptable.

My mind flashed back to the conference that had just ended. With eagerness and excitement, we filled the conference rooms—all 600+ of us—learning, speaking, encouraging, sharing, welcoming newcomers.

We broke the conference attendance record, just as we have at the last several conferences. Now over 1800 strong, our organization is growing steadily. Step by step, we are climbing higher.

Yet still, there are not enough of us. We are only a fraction of what is needed.

We need more obesity medicine specialists. We need more primary care providers who can skillfully and sensitively address weight issues. We need all medical professionals to be educated about the complexities of weight so that every patient will receive guidance and feel accepted.

And we all need to demand this of our medical providers. Every single one of them, without exception.

This is the road to freedom. Freedom from bias. Freedom from discrimination. Freedom from stigma. Freedom to pursue health.

Just like those who came before us, we can no longer accept the unacceptable.

It is time for each of us to take our next step. As we do, our perspective will grow wider and grander.

I imagine that the view at the top is awesome.


Upcoming Engagements:
  • American Association of Physicians Assistants National Conference, May 18-22, 2019, Denver, CO
    How to Talk to Patients About Weight, co-presenting with Amy Ingersoll, PA-C
    The Art & Science of Prescribing Anti-Obesity Medications, co-presenting with Amy Ingersoll, PA-C
  • American Association of Nurse Practitioners National Conference, June 18-23, Indianapolis, IN
    How to Talk to Patients About Weight
    The Art & Science of Prescribing Anti-Obesity Medications
  • Alaska Nurse Practitioner Conference, Anchorage, Alaska, September 19-21
    How to Talk to Patients About Weight
    The Art & Science of Prescribing Anti-Obesity Medications
  • Association for Counseling Education & Supervision 2019 Conference,Seattle, WA, October 10-13
    Co-presenting with Katie Christensen, MA, LPCA, NCC
    Recognizing & Reducing Weight Bias in Counselor Education & Supervision
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