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The Stages of Fat Self-Acceptance: A Conversation With Carol Normadi


Nov 4, 2011

Fat people can go through several stages before reaching self-acceptance.

Carol Normadi is a licensed marriage and family therapist in Northern California who is co-founder of Beyond Hunger, Inc., a group dedicated to helping people overcome obsessive concerns with food. She has co-authored two books on the topic of food obsessions: "It's Not About Food: Ending Your Obsession With Food and Weight" (Putnam, 1998) and "Over It: A Teen's Guide to Getting Beyond Food and Weight" (New World Library 2001).

Normadi and Diabetes Health publisher Nadia Al-Samarrie live near each other, which led to a recent conversation between them about the stages that fat people go through in accepting and dealing with their weight. In some ways, those stages-denial, anger, bargaining, and acceptance-are much like those that grieving people experience.

 

Nadia: What do you think is the source of hostility toward people who are fat?

Carol: I think maybe it's suppression of the feminine, because fat is perceived as feminine. Yet fat, happily, is what gives us the ability to have a baby. You can't get pregnant if you don't have the energy reserves-fat-to support a developing child. When we as a culture went towards oppressing the feminine, we wanted to take off all those rounded places. That's one piece of it.

The other piece is that we as a culture try to define things in terms of good or bad, so religion, ethnicity, skin color, and fat are the areas where we place shame and judgment. I can't tell you how much hate mail people in the fat acceptance movement get when they put themselves on Twitter or a blog. They get tons of hate mail-really abusive stuff. We live in a world that is fat-phobic and prejudiced against fat. So, if you're dealing with a body that is " overweight," you're going to have some shame about it because that's what you've been taught.

Nadia: Let me play devil's advocate. If you have diabetes and are "overweight," you have to worry about certain complications. There are consequences that affect not only your own quality of life, but also society. If you're not taking care of your diabetes, someone else has to pay the bill for your neglect. This is where I think the topic gets really complicated. It's not just about your image and whether people like or dislike fat people. It also involves taking on the responsibility we all have for our own health.

Carol: Yes, everybody has responsibility for their health, and everybody has a responsibility to do the best to take care of their health, whether they are thin, or have a normal body size, or are fat. The difference is that because of society's prejudices, fat people carry around a layer of shame, and that shame gets in the way of taking good care of themselves. It's not that people who have larger bodies don't need to take care of their health just as much as people with smaller bodies do. It's that their shame often leads to self-destructive behavior. So, to get people like that to really show up and take care of their bodies, you have to first take care of the internalized shame.

Nadia: Could you say that not taking care of your body is acting out and is a form of anger?

Carol: Absolutely.

Nadia: Can anger be an extension of denial? In other words, denial is where you don't see any need to cope with weight issues. But anger comes when you know you have to cope but don't want to?

Carol: Well, anger is a healthy response to being hurt or frustrated because you know you're expected to give up things you love. You know all the things you're supposed to do, and you resent them.

Nadia: Such as new considerations for your diet.


Carol: Exactly.

Nadia: And the social rituals you participate in.

Carol: Yes. Anger's a normal process. The thing is to have a relationship with your anger so that you can hear it and have other people hear it. But you have to learn how to express it without being self-destructive.

Nadia: Are there stages to working through denial and anger?

Carol: Yes. I think part of it is a matter of time. There's definitely a stage where you have to integrate your anger and get used to it and how you feel about it. I think that support is really important. If you see other people who are in the same situation who hear and understand you, and say, "Yes, this is really hard. I've been here," I think that's significant. That kind of support and information allows you to shift your thinking and focus on learning how to handle your anger and make a transition out of it. You may have a big burst of anger in the beginning, and it will continue as you hit walls along the way. But each wall you hit is part of the process of coming to terms with your anger, being able to acknowledge and express it, and finding people who can really hear you and empathize with you.

Nadia: Once people hear you and empathize with you, do you start bargaining? Is that the right term? Do you bargain with yourself?

Carol: Well, you bargain with God.

Nadia: What if you don't believe in God?

Carol: What I mean is that you are saying to yourself, "Okay, if I do this, I want the universe, or God, or my body to stop what's happening to me so I can get rid of this diagnosis." So it's your mind's way of trying to control what's happening to you. Remember, too, that all of the stages you go through may be linear, but you may not go through them in a linear way. You may move into denial, and then into anger, and then to bargaining, and then all the way back to denial in one day. So you can move in and out of the stages.

Nadia: Then bargaining is an attempt to control the outcome?

Carol: Right. You're trying to control the outcome, but can't. You can't control the diagnosis. The only thing you can do is things that support your body to be healthier. So, as you're trying to wrap your mind around having to do things differently-perhaps radically differently-you go into the bargaining stage. While you're there, you eventually come to terms with the challenge facing you. You understand that what you wanted to be under your control cannot be. But you also understand there are other things that can be under your control. That's when bargaining moves into acceptance.  

Nadia: When you move into acceptance, is it permanent?

Carol: Not always. Bargaining is the place from where you can move forward into acceptance or backward into anger. You might go back to anger because when you bargain, you're trying to control the situation by offering a sort of bribe: "Hey, if I pray every night, or if I'm good to my mother, or if I run every morning, the diagnosis will change." But when that doesn't work and your body doesn't cooperate by accepting the bargain, you get angry at it and at the fact that you're going to have to give up certain behaviors.

Nadia: It seems that you can be shifting between all of these stages all the time. It's not like you have to complete one stage before moving on to another, or that you get a certificate for completing each stage.

Carol: Yes! Monday you're in denial, and Tuesday you're angry, and by Friday you're in acceptance, but by Saturday you're having second thoughts. It just takes time and an awareness of what you'll be going through.

(Editor's Note: This is the first in a series of interviews that Nadia Al-Samarrie will be conducting with Carol Normadi on the topic of people's attitudes toward food and weight and how they can think about them in more positive ways.)


Categories: , Author Carol Normadi, Beyond Hunger, Diabetes, Diabetes, Diagnosis, Fat, Fat People, Food, It's Not About Food: Ending Your Obsession With Food and Weight, Over It: A Teen's Guide to Getting Beyond Food and Weight, Overweight, Weight Loss



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Comments

Posted by Anonymous on 5 November 2011

That is the cutest photo! What are the credits? Is there a backstory to how you came up with such a GREAT picture to accompany this article when the usual pictures are so insulting and demeaning?

Posted by Anonymous on 10 November 2011

Speaking as a registered health professional with 30+ years experience, including as a certified diabetes educator for 10 of those years, and also as someone who has had to deal with her own personal weight fluctuations --- I respectfully suggest that you need to do more to address the need to face the reality of the consequences of not managing your personal weight, in particular when you are diagnosed with health problems directly related to excess weight. In today's economy we simply cannot afford to delay with addressing the monetary costs of obesity. They impact everyone. You did not successfully address your own question concerning this important matter.

Posted by Anonymous on 10 November 2011

Thanks for your compassion Carol; Nadia, you're less so, but then, I'm fat and diabetic, so it's assumed I'm dumping on you and the rest of the medically-responsible world for my problems (SO tired of being blamed for the gynormous cost of medical care...). I'll be interested to see where you go next with this series.

Posted by Anonymous on 10 November 2011

You know, as someone who used to weigh a significant amount more than i do today, this thought hit me just the other day: folks who physically suffer with excess eight are actually doing double duty - they are hauling that extra weight up stairs, wearing it like a lead blanket when they sleep, having to sit up with it strapped to their bellies, etc. It's not that they're not working out; they're working out ALL THE TIME. And there's some biological evidence to support this. The fatigue, stress, levels of interleukin 4 and 6, and other stress or inflammatory agents circulating in the body are very similar to what athletes experience at the end of a grueling event such as a marathon. And not surprisingly, those athletes are pretty hungry after a race! The difference between the two is that the athletes get a break, have time to recover, and get a good night's sleep.

Without commenting on the prescriptive steps here for addressing biochemically dangerous outcomes of obesity, it helps adjust the mind set to realize that if you NEVER got a break in your workout, you'd experience some of the same things. It's a lot easier to be accepting and sympathetic when you realize what others are going through.

I've been on both ends of the spectrum: overweight and experiencing many of the issues mentioned, and now at a healthy weight, active, and athletic. And while I'd never go back to the "old" way, I'm still sympathetic to how I used to be.

Don M

Posted by Anonymous on 10 November 2011

As human beings we're designed to be fit and athletic. Modern day life throws a lot more stressors, obstacles and convenience into the mix, that make it hard maintain a healthy, fit lifestyle. Being overweight, and even more so - obese - is not normal, and I believe if you are either, you do not respect yourself enough and feel enough self worth to aspire to being who and what you are meant to be. At some stage you have to face the reality, and with the program, and get busy living. Don't hide behind your fat, don't use it as an excuse. Be the person you dream to be.

Posted by Anonymous on 13 November 2011

I can't take it. There are societal norms, and people are expected to try to conform to them. Things like not punching people when we are mad at them, or not taking people's things. We also like people that take the time to undertake activities like dressing in a proper manner, cleaning themselves, and controling bodily fluids and flatulents in public.

While some people are destined to be heavier than others, there is a limit to acceptance in most instances. Obiously most would feel compassion for a person that had a large tumor in their abdomen causing them to look obese. Not so much so for the morbidly obese individual eating a bag of potato chips and drinking a 64 ounce coke while tooling around in a Costco in an electric cart because it is easier than walking. Yes these are extremes, but for the majority, morbid obesity is the result of choices. Choices that most would prefer not to have made if they had a do over.

Skip the cost issues, many people make costlier choices. If most people was a person walking down the street with a load in their pants, greasy hair matted to their head, and the foulest of odors eminiating from them - we would assume they are mentally ill and cannot function in society. However, it they were otherwise normal, and proud of their choice choose not to conform to societal norms, I feel no need be polite and accomodating of their choices. I am sorry the people make choice that end them up in jail, but for some reason, they are judged to be responsible for those choices. For most, morbid obesity is the result of similar choices.

Posted by Anonymous on 15 November 2011

There is now ample evidence that it is not simply "a matter of choices." We now know that there are substances produced in the gut that control and regulate apetitie and hunger. I belive one is grelin (I'm not sure I'm spelling that right). In obese people it has been proven that these substances are out of wack. When gastric bypass is put in the picture, grelin begins to regulate and move into the normal range , even before any weight loss. So to the previous post, I wonder, if you are thin perhaps its because you have too little of this substance. Maybe we should operate on you and increase the size of your stomach because after all, it is your own choice that you are like that. Not every body type is the same, thank God. Some of us have small butts, some have big tummies, some have heavy thighs. Most of this has little to do with choice. Let those who are free of physical imperfections throw the first stone.

Posted by Anonymous on 15 November 2011

The problem is that you can not equate BMI with health or how hard someone is trying. The same behavior does not always have the same results. If obesity caused diabetes then why is it that only 30% of people who are obese have diabetes?? And why is it that there are many people who are thin have diabetes??? Everyone (thin or thick) can benefit from healthy behavior. If you make the assumption that because someone is thin they are doing healthy behavior and those that are not thin are sitting around all day eating bon bons, you would be miserably WRONG!!! Genetics have a lot to do with it as well as changes in our environment (high fructose corn syrup in everything, packaged and preserved foods, sugared soft drinks, less activity....) We have known for a long time that hormones have a lot to do with appetite and energy as well. The Oct 2011 issue of New England Journal of Medicine documents that the hunger hormone ghrelin increases with weight loss and even for at least a year after weight loss is maintained this increase remains. At the same time leptin (which decreased appetite) goes down and stays down. So you can only imagine what yo-yo diets do. If you lose weight AND keep it off the benefits wane over time. There was a large meta-analysis that showed the effectiveness of behavior on weight loss (Franz et al published in Journal of the American Dietetic Association 107(10): 1755-176) This study represented 80 well done studies including the DPP and represented 80,000 people and showed that on average people actually following a healthy diet and exercising after 2 years lost on average 8-10kg which actually matches many other studies including one published in American Journal of Clinical Nutrition 2008; 87:398-404 shows that 77% of weight is genetic and only 23% if choices/environment. Placing shame and blame is not effective even if it were choices. We as health care practitioners have taken a hippocratic oath..."if you can't help, at least do no harm." Discrimination is very harmful and demotivating, leading to difficulty maintaining healthy behavior. The lack of effectiveness is frustrating enough without all the discrimination. I know we have always thought that the world is flat because when we look out the window it looks that way. Keep in mind that Christopher Columbus WAS right even though everyone thought he was crazy. It may look like obesity is caused by indiscretions and this obesity is the cause of all evil, but if you actually look at the real evidence, obesity is just related (not causal) There is a big difference!! The same thing that causes obesity causes the other components of metabolic syndrome (hypertension, hyperlipidemia and diabetes) When you do things that cause weight loss, everything gets better AND vise versa. What you see from a distance is obesity (worn like a scarlet letter), but insulin resistance is what is under Harry Potter's invisible cloak. Please before you pass judgment, get updated on the current information. Linda Bacon's article available at http://www.nutritionj.com/content/10/1/9 is a good place to start. Her book "Health at Every Size" dispells myths we assume are facts. If you really want to help society, and decrease health care costs, encourage healthy behavior for everyone, not just those who are overweight.

Posted by Anonymous on 16 November 2011

I'm not registered, but b/c of lack of names of anonymous posters, I'll give mine: Alice. Thank you to Carol Normandi for your courage and for sharing your path to self-acceptance. This is a much needed topic for larger people. I love that you recognize it is about grieving! Bravo!I participate in a Beyond Hunger program, but have not met you. I'm glad to know there are some people who are part of that organization. What so many people don't understand (I'm referring to some who've posted here) is that the very advice doctors and some RDs incessantly give (to undereat or exercise more to lose weight) causes a host of difficulties that lead to weight *gain* for most dieters. Dieting *causes* "obesity"! Primary *undereating* causes "obesity." (Google the brilliant articles at Jean Antonello.com) My story is the epitome of that phenomenon: in the 1970s, at 14, and a supposedly "normal" BMI of 22, my ignorant male pediatrician mistook my normal, healthy, necessary pre-pubescent girl's weight gain of 10 lbs as a danger sign that I would keep gaining weight indefinitely! The idiot pediatrician didn't know it is healthy for girls to gain 10 lbs of curves at puberty. He warned me, "If you don't stop gaining weight this way, you'll be a blimp by the time you're thirty." A dumb, dangerous thing to say to a 14 year old high school frosh girl. He then put me on a 1000 kcal diet, though I was on two sports teams per day (4 hrs aerobic exercise/day.) This is starvation level, so by the first night of the diet, after a day of not eating my mother's usual healthy meals, I binged for the first time in my life, eating late into the evening. I woke the next day, stuffed, mortified, and needing to make up for the 500 kcals "overeaten" the night before, to make the doctor's weight loss of 1 lb. every 7 days, so I skipped breakfast the next day (the doctor said it didn't matter what I ate or when, just to eat no more than 1000 kcals/day, that kcals in/out is all that mattered. Many doctors still give this terrible advice on the web today.) I binged again the next night. So I didn't eat at all the next day, trying in vain to compensate again. Til nightfall. Then binged again. I fasted on day 7 to weigh in at 1 lb. less at the doctor's office. Then starved/binged the next week, followed by fasting on day 13. After that, I couldn't keep losing 1 lb/week. The first day on the diet began my next 35 years of weight gain: I discovered that first day on my doctor's diet that I needed to ignore/override my hunger to stick to the 1000 kcal goal: to tune it out, to fear awareness of hunger. Once that happens--the natural responsiveness to hunger replaced with fear of eating, leading to tuning hunger out--it can lead to a life of intended, or unintended food avoidance followed by bingeing. That is why if anyone genuinely cares about others' health, it is crucial to stop judging and criticizing peoples' body size, eating habits, and need to eat. Whatever it is our body is asking (or screaming, in a starving state) to eat. It would be enormously difficult to recover normal, body responsive, hunger-based eating even in a size accepting culture, let alone in our rabidly fat-phobic, judgmental one. The eating and weight judgment make it very hard to eat normally, to prevent bingeing and less-healthy food cravings later. It is the weight criticism + undereating advice that cause weight gain, and the *unhealthy diet/binge cycle, not the weight itself* that are almost always the cause of the health problems of larger people. Research backs this up (google Linda Bacon's HAES web site for her articles on diabetes management, etc.) I would love to automatically sit down to breakfast and lunch daily, but it is so terrifying, and I'm so used to tuning out hunger, I still rarely do, without even realizing it until 10 am or noon or 4 pm, which makes a cookie binge predictable. Think about it: if you had such a hard time eating breakfast and lunch daily that you skipped them without even realizing it, would you be craving a light salad and fruit by 4 pm, though you got up at 6 am? Or would you similarly be hitting the afternoon cookies, ravenous to recover from the low-blood sugar emergency your starved body was now in. That very plus-size person you see at McDonald's at 4 pm may be eating her first meal of the day unbeknownst to you, feel deeply ashamed but not say it, and probably has no idea that her breakfast and lunch skipping to try to lose weight to satisfy her doctor's or family's demands are causing her overwhelming, greasy, sugary cravings: because no doctor ever stops to investigate whether their plus-size clients are eating enough breakfast and lunch to prevent bingeing later. (If a doctor were to ever ask me what I ate for breakfast and lunch, and total up the calories, CHO, and fat to see if I've eaten enough, I would faint from shock to discover that they are the one and only intelligent doctor on the planet.) Don't assume that woman at McDonald's had the nice big breakfast, lunch, and snacks you did, or had anything to eat before then, at all. If you really care about plus-size people, stop assuming you know any of what's really going on with us all day, and let go of the judgments. Listen, learn, and if possible for you, even invite us to eat an enjoyable, non-dieting, but not crappy, meal with you: without judgment, advice, weight or food comment, or telling us about your latest diet, food philosophy, or "what worked for me." You know, just eat and enjoy the meal talking about something other than weight and nutrition. Learn compassion, butt out, and let plus-size people find our *own* way, with advisors of our *own* choice, thank you very much, who *we* find helpful, not you and who you think is best. Nor tell us about diet books, it just compounds the problem, as so many of us have read and been told a zillion conflicting pieces of diet advice that add to the food fears that lead to bingeing. That goes for judgmental, presumptive RDs and doctors, too, such as the "diabetes educator" who made a comment, above. To all who care, educate yourself more about eating disorders and Health At Every Size every chance you get: there is an unending amount to read and absorb online. If you really care, understand that compassion is the only thing that ever works. Kindly respect self-paced, gradual recovery of flexible, health-supporting, gentle, compassionate behaviors, instead of focusing on weight. You will have happier, healthier clients, friends, and loved ones.

Posted by Anonymous on 17 November 2011

Thanks Alice, you rock!


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