By Dr. Deanna McCrary, ND

You may be familiar with the word terrain from geography where it describes the physical features of a piece of land.   The terrain tells us whether or not crops will grow successfully there.  It tells us if the landscape is rocky, cavernous or if there is access to a lot -- or very little -- sunshine, water and minerals.  All of these things determine the types of plants or animals that will flourish on the land.  Layers of rock may reveal the history of the land -- fossils, floods or the type of vegetation that has grown there in the past.  When the land is healthy and fertile, when the soil has just the right mixture of minerals and nutrients it can be a source of sustenance, allowing many life forms to thrive.  What does this have to do with our bodies?   A lot!
               Just like the land, our bodies have a terrain – the sum of our genetic history, our personal history and choices, and our exposure to toxins. Our terrain reflects not only our inheritances but also how much access our bodies have had to sunshine, water, vitamins, protein, fats and minerals as well as pollutants, chemicals and pharmaceutical drugs.  Just as toxic waste dumps are often devoid of vegetation, a body's terrain will be affected by accumulations of toxins -- whether ingested, breathed in or absorbed through the skin.  All of these things affect how readily our bodies will resist infections, allow beneficial or harmful bacteria to flourish, prevent or allow cancer cells to grow and increase or decrease our susceptibility to any disease state.
    The concept of bodily terrain is often talked about in modern-day naturopathic medicine, however the idea has been around since the 1800s and was popular among French homeopathic doctors of the day.  The "germ theory" of health was developed in this era by Louis Pasteur (who developed pasteurization) which claims that external microbes invade the body and cause illness and that health can be regained when the germs are killed off.  Conventional medicine today ascribes to this idea and uses drugs such as antibiotics, to counteract the "offending" microbe.  A contemporary of Pasteur, Antoine Bechamp, a medical doctor put forth the idea that whether or not a disease state occurred was greatly influenced by the environment that the organism found itself in.  We are walking vessels of bacteria -- throughout our lives, all of us have germs such as staph or strep bacteria colonizing in us at one time or another.  We carry up to five pounds of bacteria in our gut alone! And yet these microbes only become problems when they are hosted in a body that supports their overgrowth or invasion into tissues where they don't normally reside.  Our bodies have their own ecosystems and will or will not support pathological organisms based on our nutritional status , genetic susceptibility and levels of toxicity.
    Be a caring, passionate gardener of your inner terrain.  Sunshine, fresh air, sleep and rest, nutrient-dense foods, pure water, laughter, surrounding yourself as much as possible with positive, affirming people and movement that brings you pleasure will fortify your inner lands and keep your garden free of any nasty bugs.
    Just as we look to maps or guides to help us navigate difficult or unknown terrain, naturopathic medical doctors can help you discover and cultivate your own inner landscape. 

© Deanna McCrary, ND and LifeJOY Natural Medicine, 2013. Unauthorized use and/or duplication of this material without express and written permission from this blog’s author and/or owner is strictly prohibited. Excerpts and links may be used, provided that full and clear credit is given to Dr. Deanna McCrary, ND and LifeJOY Natural Medicine with appropriate and specific direction to the original content.

by Dr. Deanna McCrary, ND

What is body-positive medicine? Isn’t all medicine body positive? Sadly, not always.  The medical community often over-emphasizes lower body weight as a goal to reach and maintain in order to “achieve” health.  Patients are encouraged to reach this goal by restrictive dieting and regimented exercise plans. The idea that a person can achieve metabolic health while being at a weight outside of the accepted norms is often viewed as suspect at best and medical heresy at worst. But is there a way to overall health other than by focusing on body weight?

Fortunately, the old views are starting to change—slowly. More and more research is showing that traditional dieting does not work in the long-term and, often leads directly to even more weight gain.  Also, patients are more likely to engage in physical activity if it is something that they already do that feels fun and pleasurable, and can be part of their daily life.

Further, recent studies have shown that excess body weight may actually have a protective health effect and prolong life rather than shorten it.  “In study after study, overweight and moderately obese patients with certain chronic diseases often live longer and fare better than normal-weight patients with the same ailments. The accumulation of evidence is inspiring some experts to re-examine long-held assumptions about the association between body fat and disease,” states Harriet Brown in a September 17, 2012 New York Times article titled “In ‘Obesity Paradox,’ Thinner May Mean Sicker.”

What Does “Body-Positive” mean?

To define the phrase “body positive” I will paraphrase the principles of Health at Every Size® (HAES®) as coined by the Association for Size Diversity and Health.  HAES is a health-care movement that is synonymous with body positivity and in this article I will use the terms interchangeably. To be body-positive one accepts and respects that there is natural diversity in body size and shape.  Recognizing that health and well-being are multi-dimensional and include physical, social, spiritual, occupational, emotional, and intellectual aspects, a body positive person promotes all aspects of health and well-being for people of all sizes.  A body-positive person eats in a manner which balances individual nutritional needs with hunger, satiety, appetite, and pleasure.  They engage in individually appropriate, enjoyable, life-enhancing physical activity, rather than exercise focused on a goal of weight loss. 

To be body-positive does not mean that one has reached some blissful state of 100% body-acceptance or intuitive-eating nirvana without a shred of judgment toward oneself or others, but we are on the road, reading about it, talking with others, putting some of these ideas into practice, and increasing our awareness.

What traits do health care providers who embrace these tenets have in common?  
Here are a few:

Patients Are Treated Equally
Body-positive providers are “weight neutral” and recognize that people naturally come in many different shapes and sizes and that size alone is not an indicator of overall health.  They will not immediately assume a patient has a certain health condition because of their size. They make an appropriate assessment of a patient’s health and risk factors only after getting a full history from the patient including a physical exam and any lab work or imaging studies.  For example, when meeting a patient for the first time, a HAES-focused provider would never immediately assume that a fat person binges on fast food, never exercises, has diabetes or high blood pressure, nor would they immediately assume that a thin person eats healthfully, exercises regularly, is anorexic, has brittle bones or could not have diabetes or high blood pressure.  Some of these things may end up being true but they are uncovered as a result of doing an impartial intake and not before. All patients are treated equally and are offered the same treatment and examinations given to anyone with similar symptoms or lab results, regardless of body size. 

Also, a body-positive health care provider uses weight-neutral, non-stigmatizing language.  Terms such as “obesity” or “overweight” are highly charged with negative connotations that reflect a perceived disease state rather than a normal body type that may be perfectly healthy. A HAES-focused provider would not use such terms.

No Weight-Loss Lectures
“Prescriptions to lose weight set people up for feelings of failure and deprivation and a lot of other difficulties, including teaching [patients] not to trust their bodies,” states Linda Bacon, PhD, a nutrition professor and author of the book, “Health at Every Size: The Surprising Truth About Your Weight.”  And she should know.  Bacon conducted a randomized, controlled-trial of the HAES® approach and found it is “… associated with statistically and clinically relevant improvements in physiological measures (e.g., blood pressure, blood lipids), health behaviors (e.g., eating and activity habits, dietary quality), and psychosocial outcomes (such as self-esteem and body image), and that HAES achieves these health outcomes more successfully than weight loss treatment and without the contraindications associated with a weight focus,” according to Bacon’s paper in Nutrition Journal, “Weight Science: Evaluating the Evidence for a Paradigm Shift.”

Patients Are Not Weighed at Each Visit (Generally) and BMI Is Not Used
Although there are times when it may be medically necessary to track a patient’s body weight, for example if the patient has a body-wasting disease such as cancer or anorexia, or, conversely a condition that may cause rapid weight gain such as certain thyroid conditions or Cushing’s disease, a body-positive health care practitioner will not weigh a patient at each visit.  If they are required to do so by the patient’s insurance company, they will be discreet and empower the patient with the option to know the number or not.

The Body-Mass Index, or BMI, is commonly used in the medical community as a measure of fatness in patients. The BMI was developed to be used on adult male populations only and not individuals.  Further, it does not distinguish between fat, bone and muscle when determining body weight, so its usefulness in clinical assessment has been called in to question. You can read more about the BMI here.  

Their Offices Accommodate and Welcome All Sizes
Health care providers who operate from a Health At Every Size® perspective strive to make their offices friendly and accommodating to persons of any size.  They will have a variety of blood pressure cuff sizes, sturdy chairs that don’t sit too low to the ground, patient gowns that comfortably fit both large and small bodies and an examination table with a wide, stable step-up. 

They have books or magazines in the waiting area that celebrate the variety of sizes that people come in and refrain from having books or periodicals that are about restrictive diets, weight loss schemes or that glorify one body type while disparaging others (whether directly or implied).                

They Empower Patients
Being weight-neutral and body positive doesn’t mean that discussions about good nutrition or the benefits of exercise are never discussed.  However, such providers speak more about adding in nutrient dense foods that will specifically help a condition, and less about restricting foods.  Traditional diets or food restriction with a goal of weight loss can easily back-fire.  It is human nature to want what we can’t have.  A person who feels forced by someone else to restrict certain foods (often ones they really enjoy) or a whole food group can develop an even greater desire for it than before.  This, along with the fact that our bodies are designed to keep a weight equilibrium (referred to as "set point"), are the main reasons why diets don’t work and often result in weight gain in the long-term.  A body-positive health care provider is aware of these phenomena and will help a patient release the “food police” from duty, celebrate with them the habits they already have that contribute to good health and help them uncover and remove obstacles to health.  They assist a patient in learning to cue in to hunger and satiety cues that may have been long-lost after years of restrictive dieting, and find reasonable, enjoyable physical activity in their natural body size—whatever that may be. 

They work with the patient as a team, giving the patient a voice and a role in their treatment options.  Rather than lecturing patients by blaming or shaming them for previous choices, they seek to empower by offering knowledge, guidance, acceptance, inspiration and overall provide a place of safety where a patient can feel free to be exactly who they are and explore and play with new approaches to their health.

They Have Examined Their Own Prejudices
It is virtually impossible for anyone in our society not to have culturally conditioned assumptions and biases regarding body weight.  The popularity of shows such as “The Biggest Loser” which reinforce simplistic and extreme “calories in-calories out” models of weight management are testament to our country’s obsession with weight loss not only as a health cure-all but also as catharsis to our collective fears about the social and economic consequences of weight and the perceived redemptive qualities of releasing it.  Body-positive providers have examined their own relationship to food, weight and exercise and continually seek to recognize and challenge their own internal biases when they come up.

A body-positive provider has educated themselves about the social and psychological stressors for people who fall at either extreme in the weight spectrum.  They have found ways to be accepting and compassionate about such a patient’s experiences.  They also recognize that people within the average weight spectrum may have negative views about their bodies, their relationship with food or exercise and may perceive flaws in themselves that others might not see.  This is the heritage most of us have from living in a fat-phobic, weight-obsessed culture.

Body-positive providers have educated themselves about eating disorders and are able to identify and respond to the conditions in their patient’s lives that contribute to body image and disordered eating.

Based on the criteria above do you feel your health-care providers are body positive?  We would love to hear about your experiences.

© Deanna McCrary, ND and LifeJOY Natural Medicine, 2013. Unauthorized use and/or duplication of this material without express and written permission from this blog’s author and/or owner is strictly prohibited. Excerpts and links may be used, provided that full and clear credit is given to Dr. Deanna McCrary, ND and LifeJOY Natural Medicine with appropriate and specific direction to the original content.