Weight & Well-Being

The graduate school trains counselors to embrace size diversity as part of its updated Eating Disorders Certificate program.

The graduate school trains counselors to embrace size diversity as part of its updated Eating Disorders Certificate program.

When the TV show This Is Us premiered late last year, a good deal of the show’s initial buzz focused on Chrissy Metz, who plays Kate, a character who seems to be almost completely defined by her body size and desire to lose weight.

The character quickly became a lightning rod for commentary. Was Kate a new role model for the body-positive movement, or were the show’s creators engaged in fat shaming?

Unfortunately, weight-related controversies involving those in the public eye—celebrities, musicians, and even athletes—aren’t new developments. However, they raise key health questions that apply to everyone. For example, can a person be athletically fit but still fat? What is the long-term emotional impact of fat-shaming comments? Is it a foregone conclusion that all larger-than-average people binge eat, which is a problem that can be considered an eating disorder?

These are all questions that graduate students in Lewis & Clark’s Eating Disorders Certificate program are now exploring. For more than a decade, Lewis & Clark’s Graduate School of Education and Counseling has been at the forefront of eating disorder issues. The school trains many of the counseling professionals who treat people with eating-related issues. In fact, Lewis & Clark’s Eating Disorders Certificate program is one of only a handful of graduate programs of its kind in the country and the only such program in the Pacific Northwest.

In fall 2016, the graduate school took more leadership steps in the eating disorders treatment field. To start, the program’s classes are now open to more students than ever before. The most notable change, however, is a significantly updated curriculum: “Our certificate program now includes cutting-edge social justice components that challenge the dominant narrative about eating disorders in this country,” says program director Stella Kerl-McClain, associate professor of counseling psychology.

Stella Kerl-McClain, associate professor of counseling psychology and director of the Eating Disorders Certificate program Stella Kerl-McClain, associate professor of counseling psychology and director of the Eating Disorders Certificate programAt the center of the certificate program updates are two provocative concepts: 1) challenges to scientific and cultural assumptions about fat and health, and 2) respect for body-size diversity.

Fat Not Off-Limits

Kerl-McClain says the revised curriculum may be more relevant today than ever before. Eating disorders professionals will, of course, continue working with clients who are considered medically underweight. These people may suffer from conditions such as anorexia nervosa (severely restricting food and/or exercising compulsively) or bulimia (binge eating followed by purging).

However, the so-called obesity epidemic in the United States means that counselors and health care practitioners also work with many people who are at the heavier end of the weight spectrum. Some of them may have eating disorders, while others may not. Kerl-McClain says Lewis & Clark’s updated program aims to help graduates understand the issues and treatment approaches for clients of all body sizes.

“Even if they did not start out with eating disorders, fat people often face significant pressure and social discrimination that can push them into unhealthy food and exercise habits,” says Kerl-McClain. And she says she purposely uses the word fat in her classes instead of obese. Why? Obese is a specific medical term that uses problematic concepts like body mass index (BMI) and is used as a diagnosis regardless of the person’s overall health,” she says. “On the other hand, fat is just a descriptive term for people who have more fat tissue than others. That word is not a problem unless you attach negative biases to it, such as lazy, dumb, and so on.”

Exploring Normal Body Size

A good example of the certificate program’s refreshed direction is one of its four new courses: Body Politics. This class explores cultural biases against fat people—particularly larger women. “Sizeism, as it’s often called, can be a damaging form of discrimination, similar to other types of bias,” says Professor Teresa McDowell, chair of the Department of Counseling Psychology at the graduate school. McDowell began teaching the Body Politics class in 2017. During the new course, McDowell says students learn how body size can affect relationships and power dynamics within a society. “They also learn how the very private experience of one’s own body actually is a cultural and political experience,” she explains. In other new classes, students learn about Health at Every Size, or HAES (see right). This philosophy takes “a weight-neutral approach to health,” explains Kerl-McClain. HAES, which is used throughout the certificate program, emphasizes that there may be a wide range of what can be considered normal and healthy body weights. HAES also cautions counseling and health care professionals not to assume that every fat person has an eating disorder.

“We want to educate our graduate students and, therefore, their clients, that people can be healthy and happy no matter what their body size,” says Kerl-McClain. The hope, she says, is that counselors, health care professionals, and clients alike may begin acknowledging that someone who carries extra pounds isn’t necessarily unhealthy or socially irrelevant.

Extending the Program’s Reach

Along with expanding the curriculum, the graduate school is also welcoming more students than ever before into eating disorders classes. In the past, classes were reserved for master’s degree students who planned to complete the full 8-credit Eating Disorders Certificate program, says McDowell. These students usually planned to work in dedicated eating disorder centers.

Now, however, all counseling psychology graduate students can take eating disorders courses as electives. In addition, these courses are available as continuing education credits for practicing professionals. “Understanding weight-related challenges and discrimination is important for all counseling and health professionals, not just those who specialize in eating disorders,” notes Kerl-McClain.

Student and community response to the expanded certificate program already has been extremely positive, says McDowell. A record 43 students took the fall 2016 Introduction to Eating Disorders class. Among the enrollees was Krystal Marcinkiewicz, a student in the Professional Mental Health Counseling program. Marcinkiewicz is particularly glad the certificate program will now take two years (instead of one) to complete. “The extended time will allow us, as students, to spend more time familiarizing ourselves with the material and perhaps go a bit deeper with it,” she says.

Counseling professionals also are noticing the refreshed certificate program. “There is a desire in a lot of eating disorders treatment centers—and from private-practice professionals too—to move in the direction of body-weight inclusive services,” says Hilary Kinavey, cofounder of Portland’s Be Healthy wellness clinic and training institute. “Having new graduates and established professionals come out of the Lewis & Clark program well-versed in these concepts is going to be very, very helpful for the eating disorders community.”

Teri Cettina is a freelance writer in Portland.

Health at Every Size:

Basic Principles

1. Accept your size.

Love and appreciate the body you have. Self-acceptance empowers you to move on and make positive changes.

2. Trust yourself.

We all have internal systems designed to keep us healthy—and at a healthy weight. Support your body in naturally finding its appropriate weight by honoring its signals of hunger, fullness, and appetite.

3. Adopt healthy lifestyle habits.

Develop and nurture connections with others and look for purpose and meaning in your life. Fulfilling your social, emotional, and spiritual needs restores food to its rightful place as a source of nourishment and pleasure.

  • Find the joy in moving your body and becoming more physically vital in your everyday life.
  • Eat when you’re hungry, stop when you’re full, and seek out pleasur­able and satisfying foods.
  • Tailor your tastes so that you enjoy more nutritious foods, staying mindful that there is plenty of room for less nutritious choices in the context of an overall healthy diet and lifestyle.

4. Embrace size diversity.

Humans come in a variety of sizes and shapes. Open to the beauty found across the spectrum and support others in recognizing their unique attractiveness.

Excerpted from Health at Every Size: The Surprising Truth About Your Weight © 2010 by Linda Bacon.