Recently we had a great conversation about body positivity and how new moms and birthing parents can feel good in the bodies they’re in. You also told me that for many individuals – especially those with a history of chronic dieting, disordered eating, or struggling with body image – there are a lot of points in the healthcare process, sometimes even before pregnancy and when beginning the process of trying to conceive, that can potentially be rather triggering. And because of this, establishing boundaries during this process can be immensely helpful. So if a patient is working to establish healthy boundaries with a healthcare provider, what might that actually look like in practice?
So I think it’s really important that if you know that you have some risk for disordered eating or an eating disorder or negative body image to talk about that with a therapist or qualified nutrition professional to develop those boundaries. But if you can’t afford to do that because of time, money, whatever, to just think on your own, “Okay, what are my healthy boundaries with my care provider?”
Know that you have the right to say, “I would really prefer that before you give me any food or exercise advice, please know that I’m struggling with my body image and I’m doing all the things that I can do to work on that.” So that’s really important. Because we absolutely have the right to do that.
We also have the right to refuse to be weighed at a medical appointment. Evelyn Triboli, the author of Intuitive Eating, once said that you can ask your provider to put in your medical chart, “patient politely refuses to be weighed.” So if you find the weighing process really triggering and you’re noticing it makes you feel really uncomfortable, you can say that.
Those boundaries seem like they could be such a meaningful – and empowering – advocacy tool for patients. I also have to say that – as someone with a history of disordered eating myself – these suggestions both surprise and resonate with me. They surprise me because, well, weigh-in is such a standard check-in process with most healthcare providers that I just never would have thought I could ask to not be weighed. I feel like I had really supportive medical care during both of my pregnancies, but my reproductive healthcare providers didn’t know about that history. And I remember a few weigh-ins during pregnancy with my second child where I just gained a little more weight than with my first, and even though I knew this was fine and I knew that I was eating food that was nourishing my body, it was definitely triggering – I was really surprised by how much I didn’t feel good about it, and I remember some of that old disordered thinking popping up again. And I had – and still have – such a great relationship with those providers and typically feel pretty comfortable advocating for myself! I think I would have been entirely comfortable saying, “Hey, by the way, here’s some of my medical history that you’ve never asked about. I’m in a good place now, but can we maybe skip those weigh-ins?”
Unfortunately, I think there’s a lot of pressure from what are traditionally viewed as safe, supportive places – like with a physician or even a nurse or medical assistant who’s doing the weigh-ins. And those little moments – when it’s supposedly a health care environment – can actually be extremely triggering.
We know that every single body is different with every single pregnancy, in terms of how that body is going to gain and lose weight.
We also know that all of those points of potential risk – the risk of triggering body dissatisfaction – they increase the risk of disordered eating. That’s concerning because disordered eating and chronic dieting actually increases the risk of weight cycling and chronic dieting overall increases the risk of weight gain over time.
I realize I keep talking about disordered eating, and it’s very much because there was a study that showed that almost a third of new parents who were in an intensive outpatient program for postpartum depression had disordered eating or an eating disorder. It’s extremely common and may contribute to risk of depression, or vice versa.
And when there’s stigma and bias from a medical professional, it means there’s a missed opportunity for adequate care. Fortunately, there’s more research happening around how to educate clinicians around weight stigma and ways to remove bias so that people can have more quality care. But, unfortunately, in the meantime the responsibility comes to the patient to develop those healthy boundaries.
What other sort of boundaries or filters can be meaningful?
Honestly, one easy place to filter is your social media. I think we all might have that friend from high school who is constantly selling some kind of multilevel marketing cleanse program and they actually have no health education training whatsoever. For an individual who doesn’t struggle with disordered eating or hypervigilance, they might not be impacted by that, but for a lot of people, that’s super triggering. So you want to be okay with saying, “Okay, I’m going to quiet that in my feed for a little while.” In the long run, all of that sort of stuff – cleanses, all that saran wrap fat-busting stuff – is potentially going to cost you a lot of money, shame, and stress.
So focusing on getting your health information, ideally, from actual professionals who have training in eating behavior can be very meaningful.
For example, even a well-intentioned, high-quality, very experienced lactation consultant may recommend removing a food to help a baby’s colic – and that potentially could be really triggering for somebody. There’s absolutely nothing wrong with being able to have conversations like that, but again, it comes back to making sure that you disclose, “Okay this is triggering me or making me uncomfortable.”
So in a lot of instances, it’s incredibly helpful to build those healthy boundaries and to disclose this sort of information if you’re comfortable doing so. And if you’re struggling with that, it can be really beneficial get help from a therapist.