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  • Writer's picturePaige Smathers

62: How Each of Us can Help Prevent Struggles with Food and Body Image

"No one is responsible for causing eating disorders...but, everyone is responsible to help prevent them." This was one of the many amazingly profound things Dr. Levine said during this podcast episode.

Dr. Michael Levine is a retired psychology professor who has spent the majority of his career researching the question of how to prevent eating disorders. His career has been full of advocacy for women, body image concerns and prevention of eating disorders.

In this episode we talk about his research and advocacy. We also talk about how each of us can help shift the tide toward a better cultural environment that decreases the risk of eating disorder development. He also shared about a specific intervention that a world-renowned body image researcher did with a group of ballerinas that had incredible results and that is directly related to how each of us can improve our personal relationship with food and our bodies.

You are going to love this conversation with Michael! His ideas about prevention and advocacy are so important for the health and happiness of the rising generation and each of us.

Links mentioned in this episode:

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Full transcript:

Paige: Hi everyone. Thanks so much for joining me for another episode of Nutrition Matters Podcast. I’m Paige your host and I’m so glad that you’re here with me today. Today I’m interviewing Dr. Michael Levine who is a retired psychologist and professor and he has done decades of work in the field of eating disorders, in prevention and advocacy, as well of gender issues and feminism. He is a champion of all of those things and had such a great perspective on the topic today which is...we’re going to be talking about what each of us can do in our own lives and in our own selves, plus in our communities and families to help prevent eating disorders. Now you know eating disorders are complex. It’s not one easy thing we switch that changes it. But wouldn’t it be useful to talk about how we as a culture can changes and do a little bit better to support each other and love each other better to help prevent eating disorders that are preventable. You know there are some that aren’t, but there are some that are. And so I really enjoyed his perspective in this episode and he offers a lot of important insight and wisdom and he is just a great guy. I think you’re really going to enjoy this episode, so sit back and relax, and enjoy it.

Paige: Alright, well Dr. Michael Levine, thank you so much for joining me on Nutrition Matters Podcast. It’s so fun to have you.

Dr. Levine: Well, thank you. I’m delighted to be involved.

Paige: Yay! Okay, so tell us about you beyond what we’re going to be talking about today. I mean I think it’s kind of fun for the listeners to know what you just told me before we started recording about how...what you see out your window and what you have in your backyard. (laughing)

Dr. Levine: (laughing) Umm, I am a retired college professor. For over thirty years I was a professor in the experimental psychology program at Kenyon College in Ohio. I grew up in Southern California, in Claremont, California which perhaps not so ironically is a small college town and I managed to make it all the way to a small college town in Ohio. I went to school as an undergraduate and graduate student at the University of California at Santa Barbara. It seemed at the time I was going far away from home. It’s about a hundred and twenty miles from Claremont…

Paige: Yeah. (laughing)

Dr. Levine: ...and I fell in love with Santa Barbara.

Paige: How could you not?

Dr. Levine: It’s an expensive affection…

Paige: (laughing)

Dr. Levine: I fell in love with Santa Barbara and as I look out my study window, I see the mountains about 10 miles away. They’re big mountains. And behind me about a kilometer--6/10 of a mile--is the Pacific Ocean. So, I’m on part of what was a flood plain--water coming down the mountains toward the Pacific. It’s not been developed to some extent. UC Santa Barbara is about two miles to the east of me here. The land from Santa Barbara juts out to the west, so interestingly UC Santa Barbara is about nine miles west of the city even though they are both on the ocean.

Paige: Oh, interesting. I like that little tidbit. So, I really want to get into talking all about you and your research and all of the things that we’re going to talk about today, but I just get so intrigued by anybody who’s retired and I just want to know what life is like. What do you do with your time? Do you volunteer? Do you hang out? Do you go to the beach? What’s your life like?

Dr. Levine: Well, umm anyone who knows me will not smile when they hear that I’m very involved in a lot of the work I was doing when I was a professor. (laughing)

Paige: I believe it! How do you just stop, right?

Dr. Levine: Yes, and in part it’s become who I am and what I’m passionate about and that’s how you and I met…

Paige: Right.

Dr. Levine: a conference that I was invited to speak at and I still do a fair amount of speaking, a little bit of writing. My colleague Linda Smolak who’s a world renowned developmental psychologist working in the body image and eating disorders area, she and I are revising a prevention textbook that we wrote…

Paige: Great, so you stay busy with work stuff. (laughing)

Dr. Levine: Yes, stay busy.

Paige: On top of fun I’m sure.

Dr. Levine: Yes, and then I like most men in their sixty’s, I have “a few health issues,” and so I am doing what I can to overcome some fifty to sixty years of relative inactivity, sitting in front of a computer for far too long with too many cups of coffee and too many granola bars and not enough exercise. So my wife and I are working out with a personal trainer a couple of times a week and trying to workout and walk everyday. Trying to ….

Paige: What a great place to do that right?

Dr. Levine: ...yeah, get out with the dog. There’s a lot of places to walk around here and it’s just such a privilege to walk out to the ocean and walk along the bluffs and look down at the ocean and up at the mountains and it’s beautiful here. We haven’t quite decided what we’re going to do in terms of volunteer work and things of that sort. I still do a fair amount of volunteering for various eating disorder organizations that I’m a ...consultant is putting too big a spin on it. I have friends who work there and I help out when I can…

Paige: Great!

Dr. Levine: with_________ related matters. I also have what seems like endless to read and reading is one of my guilty pleasures and I am reading three or four books at any given time and probably able to read a couple books a week.

Paige: Good for you!

Dr. Levine: Yeah, so I highly recommend being retired if one is in a position to afford it and we fortunately are.

Paige: Well, it sounds like a great life there in Santa Barbara. So, you’ve mentioned this a few times and this is really going to be what I’m assuming the theme of our conversation today because this is what you’ve really dedicated your professional life to looking deeply into prevention of eating disorders. Is that right? Do I have that right?

Dr. Levine: Yes and interestingly, that professional life didn’t really begin until I was in my early thirties and working as a young college professor in central Ohio. I had nothing to do with ….

Paige: Interesting.

Dr. Levine: ...body image or eating disorders or any related topic when I was an undergraduate or graduate student. I had heard of anorexia nervosa, but I’m old enough to have been educated at a time when it was considered such a rare if not unusual disorder that it might not even exist.

Paige: Wow, it’s so different from now huh. (laughing)

Dr. Levine: I was teaching abnormal psychology and not even covering anorexia nervosa and I had never even heard of bulimia nervosa. This would have been 1981, 1982, 1983, and then as fate would have it, my wife became one of the founding mothers of the domestic violence shelters in the tiny, rural county that we were living in. And one of the first things that these non-profit organizations do it they set up a speakers bureau and they needed a male person to be on their speakers bureau and I had done a portion of my doctoral dissertation on a phenomenon know learned helplessness that was related to some current theories about domestic violence. So my wife asked me if I would be that person in a way that sives and partners ask other partners would you be willing to. So for the first time in my life--I was in my early thirties--I began to speak to the public and the community about domestic violence and about gender roles and about “what was normal and what was abnormal” and what did it mean when a man said, ‘well my wife and my kids belong to me.’ I had never thought about any of these issues.

Paige: Wow. Okay so you already had your PhD. You were already teaching.

Dr. Levine: I had my PhD. I had done my doctrinal dissertation on coronary prone “Type A” behavior…

Paige: Mhmm.

Dr. Levine: ...and I had not really thought much about gender, which doesn’t make any sense in retrospect either thinking about type A behavior. I had really no background in eating disorders and somebody saw me give a talk on domestic violence and asked me if I would come to a mental health association meeting and give a talk on bipolar disorder. I was teaching that kind of material...

Paige: Mhmm.

Dr. Levine: ...and I did and I was so young and naive and I didn’t know this was part of the recruitment process. This is how they get people onto the board….

Paige: Oh. (laughing)

Dr. Levine: ...of the Mental Health Association.

Paige: Ahh. (laughing)

Dr. Levine: I ended up on the board of the Mental Health Association and one day we were sitting around--1983 in the spring--and somebody said, ‘We should do a whole weeks worth of programs instead of one little newspaper article or radio program about ADHD or about post traumatic stress disorder or about Alzheimer’s disease. Let’s do a whole weeks worth of programs and integrate them--materials for the schools, materials for the public, materials for physicians, a training session for psychologists and social workers and dietitians.’ And somebody said, ‘You mean like one of those stupid awareness weeks?’ (laughing)

Paige: (laughing)

Dr. Levine: Somebody said, ‘We don't’ have to call it an awareness week, but yeah.’ Somebody said, ‘Well what should we do it on?’ and just then, the physician for Kenyon College who wasn’t on the board stopped into the office and overheard the conversation and he said, ‘You should do it on anorexia nervosa and bulimia nervosa because we’re seeing more and more problems on college campuses.’ I thought he was joking. I had never heard of bulimia nervosa and anorexia nervosa, as far as I knew, was a rare and controversial disorder. He said, ‘I know a woman in Columbus, Ohio about 15 miles away who runs an eating disorder organization.’ I thought, ‘Now he’s really joking. There’s no way.’ And sure enough there was a woman, who became one of my mentors, Amy Baker Dennis, who was running the Center for the Treatment of Eating Disorders and the National Anorexic Aid Society in Columbus, Ohio. So our little mental health association ended up in the fall of 1983 putting on the first Eating Disorders Awareness Week in the United States.

Paige: Wow! And that’s still going on to this day.

Dr. Levine: Yes and we then sold the concept....

Paige: Oh, did you. Okay.

Dr. Levine: Amy’s organization for probably $1000, which was the entire budget for education for the Mental Health Association back then, and Amy and some other people met in the late 80’s to make this more of a national phenomenon. That’s really how what is now the National Eating Disorders Association, as many of people have heard of NEDA, that’s how it began in the the late 1980’s. A group of people connected to Amy and this concept picked it up. And so that’s how I got involved in it. I did this Eating Disorders Awareness Week. I was the one primarily responsible for it, although I was working with a group. Adn I put it in a drawer and went back to being a professor and Amy Dennis then called me in April and said, ‘We do a conference every year. Would you like to make a presentation?’ I said, ‘Sure.’ I didn’t know quite what she wanted. So that’s how I began to meet all these now famous people in the field--Craig Johnson, Chris Fairburn and all these people that Amy Dennis knew. One thing led to another…

Paige: Good for you!

Dr. Levine: That’s how I got involved in community awareness, advocacy, and eventually prevention.

Paige: Okay, I wanna talk about prevention specifically because I think that’s a very juicy topic don’t you think? There’s elements to that, that I think can be misunderstood and you know when we’re talking about just an individual who develops an eating disorder, the people around them often think, ‘Oh it’s my fault. I did something wrong. I needed to prevent it,’ right? So there can be a lot of guilt and just terrible feelings with support people and people who love the person who's struggling. Is that the type or work you’re talking about? Sort of debunking some of those myths of like people being responsible for other people developing eating disorders. I think there’s also like that public health aspect too right....

Dr. Levine: Mhmm.

Paige: ...where it’s more global, so I just want to kind of get specific about what your research over the years about prevention has been and what you’ve learned from it.

Dr. Levine: Yes, that’s a very good question you’ve asked me and I’ve been wrestling with that more rather than less since I’ve gotten involved in the field.

Paige: Isn’t that the way it goes?

Dr. Levine: Yes.

Paige: The more you learn about something, the more questions you have. Don’t you think?

Dr. Levine: That’s right. And the less ___________________ maybe 20 years ago.

Paige: Oh, so true.

Dr. Levine: On the one hand, as you know from your work and from podcasts and the many people you touch, blame, shame, guilt...these are not productive emotions. They are not productive experiences. People struggling with eating disorders--their own, those of a family member, their own AND those of a family member--are struggling with enough that the last thing that’s going to be helpful is more shame, more blame, more guilt. On the other hand, my mentor who I mentioned, Amy Baker Dennis, is quite fond of saying--and she’s been saying it for years and years and years--’Nobody is responsible for causing an eating disorder and everyone has a responsibility to contribute to recovery and to prevention.’

Paige: I love that.

Dr. Levine: So walk the fine line between not blaming people and saying there are things all of us can do as citizens, as professionals--if we happen to be teachers or dietitians or psychologists or coaches or physicians--and as people. There’s something that all of us can do to create a set of cultures that are much, much healthier. I’m sure you’ve talked to many people who are recovering or who have recovered and they talk to you about how difficult it is when one leaves an intensive outpatient program or one leaves an inpatient program or one returns to school or returns to their job or returns to what they’re doing because the culture itself seems so preoccupied with weight and shape.

Paige: Absolutely.

Dr. Levine: The culture seems so intent on idealizing thinness and debasing fat and fat people. The culture itself seems so intent on equating women with their looks and their appearance and control of their appetites. I’m sure you’ve encountered people who’ve said, it’s really hard to be a healthy person in such a--I’ll say if not sick at least such an unhealthy culture.

Paige: Yes, and you know once you become sensitized to these issues you see it everywhere and it can sometimes feel like a little bit of a burden to become aware of all the many issues we have culturally around food and shape and body image because it’s exhausting…

Dr. Levine: Yes.

Paige: encounter it at every turn, right?

Dr. Levine: Yeah, and we’re trying to say to people who are recovering--you’re a clinician, I am not--but it’s pretty clear that you are trying to communicate to people who are recovering, there’s so much more that you can be and so much more to you and so much more that you can be thinking about than weight and shape and calories and scales and charts and graphs. And at the same time the culture is saying in so many ways, whether it’s tv shows, magazine articles, blogs, and of course one need only look at the recent political campaign, one need only look at a celebrity news, one need only look at, umm...was it George Clooney’s wife who is an internationally renowned civil rights attorney addressed the United Nations about civil rights for women and civil rights for workers being abused and so on, and the only thing they could comment on was the dress she was wearing and her “baby bump”?

Paige: That’s everywhere.

Dr. Levine: It’s everywhere and so what I’m committed to doing-- and more and more people are, I’m pleased to say over the years--committed to thinking about that is envisioning and working toward a world where fat is not a dirty word. Where women of substance, no matter what their size--because some women of substance are tall and slender, and some women of substance are short and stockier, and some women of substance umm have a, you know Native American backgrounds, and some have Eastern European Jewish backgrounds and some have Chinese...I mean I’m committed to creating a world in which people in general and women in particular of substance are not denigrated because they’re not thin enough, they’re not tall enough, they’re not white enough, they’re not in control enough, they’re not appleasing enough, they’re not quiet enough…

Paige: Absolutely.

Dr. Levine: And I think that if you ask parents, whether it’s parents of people who are recovering or parents in general or you ask big sisters in regard to little sisters, or big brothers in regard to little sisters, do you really want your sister, your daughter, your granddaughter, your niece, your spouse to grow up in a world where she feels crushingly self concious, where she identifies herself totally with her weight and shape, where she thinks she’s a bac person if she eats three potato chips and that she otta exercise for an hour afterwards. Do you really want her focused more on the size of her thighs than on world peace and coping with the problem of hunger and helping people avoid sicknesses. Is that really what you want for your daughters and your sons and so on? Most people are going to say no! That's not what I want. That’s not what I want to stand for and yet we all seem entrapped sometimes, enmeshed, encased in an interlocking set of cultural factors that really serve to really promote a lot of unhealthy messages that in the extreme become encapsulated in the eating disorders.

Paige: Right and there is that extreme, but then there’s also just the rest of the people right, who are just saturated in this culture that normalizes all of these completely disordered behaviors and thought process patterns that are not in our best interest and that are not healthy for us, you know

Dr. Levine: Exactly and I think that on the flip side, Paige, it’s also the case that when I was growing up, there were a lot of schools particularly in Southern California, a lot of good schools like the one I went to, Claremont High School which did not have varsity athletics for women. There are a lot of...growing up domestic violence was something of a joke. It was up to males to control their women. Dating was seen as a predatory activity. Men were predators, women were prey. Drunk driving was the subject of a lot of humor on television and subject to boasting by males. I mean...and if you were to have stood up as a young man or young woman, as a young man in those days and said ‘this is crazy,’ you would have been seen as joking at first and then you might have been seen as, what are you, unmanly? And you might have been called a word that rhymes with bag and starts with f or something like that.

Paige: (laughing)

Dr. Levine: People might have tried to shut you up physically and yet, look at how much things have changed in the last thirty, forty, fifty years. We have a long way to go, but drunk driving is no longer a joke.

Paige: Thank goodness for that.

Dr. Levine: Yeah, thank goodness. And now if you were the superintendent of schools and a new family moved in and they said, ‘Our daughter is an excellent field hockey player. What are her opportunities?’ and you said ‘We don’t have any sports for women because we’re afraid it’s going to compromise their reproductive status,’ you’d...they would think you were joking and if they didn't, you’d probably be the subject of a lawsuit. It’s against the law to discriminate on that basis. And domestic violence...there’s increasing awareness about the problems, even the National Football League is beginning to raise it’s awareness and to take actions. So what I’m getting at here, when I was growing up, there were a lot of parts of culture, particularly masculine culture and feminine culture in the 50’s and 60’s that were seen as part of the “natural order.” That’s the way things are here in America. And now we look back on that, at least many of us, with some horror and we’ve seen the progress that’s been made. I’m hoping that I’m part, and so are you and others, are part of….

Paige: A change.

Dr. Levine: ...a revolution.

Paige: Yeah.

Dr. Levine: A massive change that will be healthier on many, many levels because we know that negative body image for instance is a risk factor for depression and probably for some forms of social anxiety in young girls. We know that negative body image is associated with the abuse of substances and the abuse of--including nicotine--but the abuse of other substances. We know that in general when people feel badly about their bodies, they tend not to take as good care of themselves. The whole notion that we should be shaming fat people because that will help them lose weight is scientific garbage and is inhumane, cruel nonsense. When’s the last time somebody shamed you and you said, ‘you know what I feel like that really was helpful.’

Paige: Michael, this is just...I just want you to preach on because this is what I talk about all the time. I loved that line that you said about like when’s the last time being awful to yourself has helped you…

Dr. Levine: Yeah.

Paige: ...or led to healthy behaviors. It’s so easy to see that when we’re talking about, you know parenting and our children and when we yell at them or shame them, do good things happen? Of course not or when we were a child and that was done to us. Did good things happen? No. We just felt like absolute crap, you know, whereas why do we think it’s okay to do that to ourselves?

Dr. Levine: Exactly!

Paige: Or to other people.

Dr. Levine: Many clients I’m sure they’ll say, ‘Oh, I have several good friends and the kind of people that come and talk to me when they’re in distress and I’m a good listener,’ and so on. What you’re saying about families, I mean why is it that we can be compassionate and understanding and say things like, ‘Everybody makes mistakes. You’re being too hard on yourself,’ whereas when it comes to us, many people see that if you’re not self-critical then you’re some kind of loser or your....

Paige: Right. What is that?

Dr. Levine: You’re morally lax or you have standards and you’ve just kind of given up. It’s that kind of all or none thinking. If I’m not totally hard on myself and driving myself...this know I never saw the connection when I was studying type A behavior and mostly men being this notion that there’s a set of values that are somehow a really essential part of your gender and a central part of success and so what, you’re going to compromise your heart? And when people say, ‘I’m gonna to beat this damn job even if it kills me.’ Suppose that were true. (laughing)

Paige: Yeah, like take that literally. (laughing)

Dr. Levine: Yeah, yeah. I’m gonna beat this damn job even if it breaks my heart literally. And this notion that well if I didn’t have high standards, if I wasn’t constantly commenting on my behavior or observing it, then I would just you know, I would just give up and then I would eat everything in sight or I would umm, I would have no standards and I would be a loser. You have to say without being cynical, without being harsh to your clients in some way, ‘How’s that working out for you?’

Paige: Right, and that’ does that make any sense, like in your experience? When has that lead to good things for you?

Dr. Levine: Or if you could take that voice and transfer it to your sister, your little sister who’s eight or nine or your niece who’s seven. Would you choose to do that?

Paige: No. No person would.

Dr. Levine: No and what would you choose to transfer if you had to do over again? What would you...and in some ways we do have it to do over again--both in our own lives and also in the lives of those people who have clients, people who teach, people who have...we all do. I mean we have family members, we have charities we give to, we have jobs, we have things and I would like to see massive changes in the way we relate not only to each other, but also the way we relate to food, to weight, to shape...

Paige: Yes.

Dr. Levine: health. And these are going to be tricky, but...

Paige: So that’s the revolution you’re talking about right?

Dr. Levine: Yeah.

Paige: So, original question was tell--basically really open ended--tell me about prevention, it sounds like that’s sort of what you have in mind on a global, grand scale. Like both the internal, very personal journey of doing your own individual work in this regard, but then you know, treating people a little bit kinder in our own world as well and changing the culture of how we relate to food and shape and weight and all of those things sort of on this revolutionary level of…

Dr. Levine: Yeah.

Paige: ...there’s no wrong way to have a body and let’s learn to love ourselves and take care of ourselves.

Dr. Levine: And you could have that attitude and those practices within your family.

Paige: Mhmm.

Dr. Levine: You could have that attitude and those practices within your group of friends. You could...there are various social groups that we belong to that we have some input into.

Paige: Yep. Very true.

Dr. Levine: When we go to lunch with our friends or we go to dinner with our friends and somebody starts talking about, ‘Oh I can’t eat that because…’ I mean, we can make rules. We do it all the time and there’s a way to do this that’s not offensive and just say that...especially if you...and people say well I don’t know how I would talk about that, which is an interesting thing. These are your friends that you talk to about our sexuality, you talk to them about your parenting, you talk to them about some of your deepest fears, you talk to about your likes and dislikes, you tell them things that you don’t tell other people. And yet we can’t talk to them about things that really matter to this world regarding body image and weight and shape.

Paige: What do you think that’s about? Is it up there with religion and politics? Just don’t talk about it? (laughing)

Dr. Levine: Well I think that it is and I think that part of the weightism is that if you have to talk about it then you haven't been successful at it.

Paige: Mmm.

Dr. Levine: That only losers would talk about this.

Paige: Mmm.

Dr. Levine: You know, what is it that umm...there’s a famous movie with Jim Carrey, I can’t think of the name of the movie. He’s talking to his little boy about…

Paige: Oh, is it Liar, Liar?

Dr. Levine: Yes, Liar, Liar.

Paige: One of my favs.

Dr. Levine: The little boy says...Jim Carrey says...he makes some comment about a woman. The little boy says, ‘That’s not nice. It’s really what’s inside that counts.’

Paige: Aww.

Dr. Levine: Jim Carrey says, ‘Well that’s what ugly people say just to make themselves feel better.’

Paige: Oh I do remember that part of that movie!

Dr. Levine: Yeah.

Paige: Yep.

Dr. Levine: There’s so many people who feel like well if you’re talking about this, if you're challenging it, then you...then somehow you can’t keep up. It’s your way of being a loser in this regard and trying to rationalize it. Like everybody knows that being fat is bad for you. Everybody knows that being thinner is better. Everybody knows that fat people eat too much and that thin people have better eating...I mean all these myths that have been shown time and again to be scientifically invalid in many ways or that scientifically have been shown to be much more complex than what we’re saying. We just want to go with this sort of lazy myth that we’ve...many of us were raised with and I think that people who want to challenge--particularly women who want to challenge it are seen as aggressive, bossy and that’s go it’s own threats now for women who are not being feminine and demure and, ‘Oh, you’re complaining about this, you’re complaining about that. You just can’t lose the weight.’ I mean…

Paige: Right. That’s…..

Dr. Levine: It really does take women and men working together to talk about these things and it’s not easy to talk about. It’s not easy for me to talk about body image and body shape. Why when I look in the mirror do I tend to see my father and his shape and weight? (laughing) Why does that bother me? And why don’t I have...I mean I’m a body image expert of sorts. Why don’t I have a better body...these are painful topics in some ways, and yet we don’t make and take the time to talk about them with ourselves. How are we going to talk about them to our children? How are we going to talk about are we going to make rules in our family, rules in our workplace, rules in our church, rules in our synagogues? How are we gonna do this? How are we gonna have this unless we raise our own awareness and we do it in relationship to other people?

Paige: So what I’m hearing is it really starts with you as your own individual self…

Dr. Levine: Yes.

Paige: ...just doing this work.

Dr. Levine: Another of many Ghandi quotes that some people have on their websites--’Be the change you want to see in the world.’

Paige: You gave a quote that I actually really loved in your presentation that I went to recently. You said, ‘If you want to truly understand something, try to change it.’

Dr. Levine: Yes.

Paige: That really stuck with me. I was like, ‘Whoa. that is so true.’ And that’s sort of what we’re talking about here is we want to change the culture and the...our own individual selves and our families and our communities. That’s the best way to you know...if you want to try to understand it, try change it because you will really have to dig deep to figure your own self out and your own issues out.

Dr. Levine: Yes, and let me give you an example of that that comes to me in some way reverse. If you want to change something, you need to make time to truly understand it.

Paige: Yeah, yeah. It goes both ways.

Dr. Levine: One of my friends and role models in the prevention area is a Toronto Psychologist. Her name is Niva Piran. She’s originally from Israel and she now teaches at the University of Toronto and she was asked to consult with the Toronto Ballet School. This is the school--the residential school--that produces a large number of the dancers for the internationally renowned Toronto Ballet Company. Most people would say, ‘You’re gonna do prevention work in a ballet company? No way! You don’t have a prayer of making any change in the world of ballet. In fact this is a high risk occupation and what could you possibly do?’ People who say something like that don’t know Niva Piran. She spent I think six to eight months working as something of an anthropologist in the ballet school. That is she visited classes, she spoke with the staff, she spoke with individual students, she gathered together groups of girls, may of whom were 13, 14, 15, 11, 12, 13, 14, 15, and instead of saying to them you know how ballet has this emphasis on weight and shame, here’s what you have to do. Instead of talking at them, she said to them ‘What do you think are the factors going on in this ballet school that leads girls like yourself to be really self-conscious about their weight and shape and really feel badly about their bodies and do things that are not healthy. What do you think is responsible here?’ And the immediate reaction--not surprisingly--imagine you posing that question to a group of elite 11, 12, 13, 14 year old girls who’ve been accepted to this ballet school. They’re talking in private to a psychologist. The initial reaction was complete silence. No one wanted to be that “loser” who was going to speak up and say ‘Well what makes me feel bad…’

Paige: Yeah. (laughing)

Dr. Levine: These are people who are trained to dance with pain. Trained to stifle their feelings. Trained to work through difficult situations. trained to spend hours doing things other people can’t handle. There was complete silence. It took her awhile to build their trust in her and their trust in each other. And when they did begin to speak, interestingly Paige, they all had pretty much the same answer.

Paige: What was it?

Dr. Levine: Public knowledge that was being suppressed privately by each of them and it was that many of the teachers, particularly the male teachers, felt freely to grab, pinch, fondle, comment publicly about their young and developing bodies. It wasn’t that there were pictures of thin dancers on the walls. It wasn’t people telling them, ‘Don’t get fat. Don’t get fat. That’ll crush your career.’ It was the objectification of their bodies by certain male teachers. So what Niva then did and anyone who wants to know much more about this can look her up or can email me at and I’ll send you a lot of references. I’ve had the pleasure and privilege of working with Niva on a number of things. What Niva then did was to say to the girls, ‘What do you...what would you like to do about this?’ And again there was silence because everybody knew what they wanted to do about this. They wanted to tell somebody in authority to do something about it and if the person wouldn't stop, to get rid of them. But nobody wanted to be that one person to speak up. Nobody wanted to be that one person to get somebody else in trouble or make waves. She worked with them and they all agreed that they wanted to draft a statement to present to the administration, so she worked with them. In other words, she got them involved in raising their own awareness, in connecting with each other, in developing a plan and sure enough, she did this with males, she did this with females, she did this with older females. She did this for about a year and over the subsequent years the prevalence of eating disorders in this ballet company went down. Down significantly. So in other words, in a setting that most people would say is not only high risk for eating disorders, but that’s there’s really nothing anybody could do about the culture of ballet, Niva was able to be an advocate for the girls, a mentor for them, a facilitator for them in working with the administration. And the administration was willing to listen to her because everything is advocacy and she was advocating to them as well and they began to make changes in the behavior of some of the staff and getting rid of some of the staff. She also worked with the girls to make changes in their own peer group behavior because of course some of the girls were hader on other girls. Not because they’re girls, but because groups of people are hard on each other othen. Boys can be really savage, I can tell you from experience. Girls can be harder on each other. She worked with them. She worked with them to understand what was it about their experience in the ballet school that was making it difficult for them to be healthy. Making it difficult for them to dance more artistically because of course if you said, ‘You know what? In order to be a great ballet dancer, what you need is an eating disorder.’ That’s crazy! I mean that would be like, in ordre to be a great football player, you need to have as many head injuries as you possibly can accumulate.

Paige: (laughing) Yeah.

Dr. Levine: Or you need to have more broken bones, so...I mean yes, people make sacrifices to do these things, but this kind of work suggests that yes, we need to understand things in order to change them--back to your quotation. At the same time, in order to change them, we need to understand things, not only from the top down--the kind of expertise that we have as experts on eating disorders--but from the ground up.

Paige: I love that so much!

Dr. Levine: Many people know...I mean who would be more of an expert on middle school life in Fresno, California? A Fresno middle schooler or Michael Levine with a Phd, who’s living in Santa Barbara and hasn’t been in middle school we’ll say in a while?

Paige: (laughing)

Dr. Levine: Now, no matter how much time I spent studying middle schools, what’s happening on the ground in that middle school is known to the people in the middle school. And if you say, well they don't care. If you get cynical about it--they’re adolescents, they don’t care, they’re wrapped up in their own self-consciousness, they don’t care about their fellows. Talk to middle school students. Talk to high school students. Talk to college students. The ones that I work with, many of them care deeply about their peers. They care deeply about issues of health and many people they care deeply about equity and fairness and safety. Same things the schools care about and a lot of what you and I are talking about here has to do with trying to work away from bullying and teasing and weight and shape consciousness and the kinds of things that--they don’t cause eating disorders, but they certainly can trip you too it. They certainly intensify the nervosa part of anorexia nervosa and bulimia nervosa.

Paige: Michael, so back to that story about the ballet school, I really think that that’s a powerful story, so I’m glad you shared that. I wrote know the basic question she asked the girls was, ‘What are the issues going on?’ and then, ‘What do you want to do about it?’ ‘What are the issues that are getting in the way of you being your healthiest self and what should we do about it?’ And that was a powerful example of how that had a positive affect in that little circle there, but I really feel like there’s some power in general to that model, right….

Dr. Levine: Yeah.

Paige: ...where we can do that ourselves. We can say, ‘What are the things getting in my way?’ It could be something as easy as, ‘Well I have this full length mirror in my room that every single time I walk in and out of my room I see my legs and I start screaming at myself in my own head about it. Maybe I need to just take a break from the full length mirror. Maybe I need to just focus on my head up for a while. Maybe there’s some elements of my day or my behavior or my life or the people around me that are getting in the way of me being my healthiest self. So what do I want to do about it? Well, take some action, you know. I think we can do that with ourselves. I think we can do that with our kids. When appropriate, ask those questions.

Dr. Levine: Yes I think you can do it also with your friends…

Paige: Yeah!

Dr. Levine: ...or with people to whom you are close. This is some ways the personal is the political.

Paige: Yeah, I agree.

Dr. Levine: If this is something that I’m thinking, you know what every time I walk by that mirror, I get a little pang or stab, and yet my response is often to walk by it more or turn around and look the other way, I wonder if my friend has that similar experience. And this is an intimate thing to talk about because nobody wants to be ridiculed. Or if you have a partner you can talk to about that, this is where partners can take this seriously. A lot of people say, ‘Oh this is just womens crap. Women are self conscious. That's just women being women.’

Paige: Hey, guys are too.

Dr. Levine: Yes, and it’s us as citizens being socialized to do this. Women are not born looking into mirrors.

Paige: I can attest to that. I have two little girls and they're’ not shy and they love themselves. (laughing)

Dr. Levine: Yeah, and they’re not..anymore than little boys are. You know and the notion is that you ask your daughter, ‘Is the mirror your friend?’ I mean, that question doesn’t make any sense, right?

Paige: Right. No.

Dr. Levine: Yeah, no, and I said in my talk if you may remember...if I leaned over to you during an experts talk and I said, ‘Paige, the mirror is my enemy,’ I mean you’d be concerned about my mental health.

Paige: (laughing)

Dr. Levine: You’d really be concerned if I believe that the mirror was my enemy and yet, we have to take seriously when someone says I feel like I’m in a war with my mirror and I just don’t know what to do. I can’t look away, but everytime I look… To have some to talk to about that. To have someone who you can say, do you ever have that experience? What do you think about…? And then maybe the two of you agree, let’s cover the mirror for a week and see what happens. If we’re wrong, we’ll just laugh about it. It didn't make any difference. If it did make a difference we’ll talk about that. And that may feel like a very intimate… When I’ve taught these kinds of things--I think I’ve mentioned this to you before--when I’ve taught these kinds of things in class, it’s often hard to get students--even if they’re all female in an eating disorder seminar for instance--to talk about these things because they’re so intensely personal. These are students who will talk about substance use, they’ll talk about sex, they’ll talk about really intimate stuff in class, but when it comes to body image there’s something so intimate and personal and fundamental about our relationship to our body and our feeling in our body and our image of our body. I know eating disorders are more than body image issues.

Paige: Yes. Yeah.

Dr. Levine: But body image is a fundamental part of most eating disorders and one of the things I think we as a culture can do to create a healthier environment for everyone is to begin to understand how we’ve all been complicit whether it’s media, whether it’s pornography, whether it’s objectification, whether it’s bad advice from dietitians, psychologists, physicians, doctors. How we’ve all been complicit in this notion that your weight and shape are one of the most important things about you. They speak volumes, many people believe and if you don’t have the proper or the ideal weight and shape, then there’s something wrong with you. And what’s wrong with you is your fault--meaning you ought to be trying really, really hard to obtain a more ideal weight and shape. And if you can’t do that, that’s your fault too. Fault upon fault. Self consciousness upon self consciousness. Guilt upon guilt. You know the old Chinese finger puzzle trick…

Paige: Right.

Dr. Levine: ..where you put your finger in there and you try to get out…

Paige: Yep.

Dr. Levine: ...and the secret is to push go toward the tension rather than pulling away from it.

Paige: Yeah.

Dr. Levine: I think that’s what we need to do in this regard is we need to move toward this, rather than not thinking about it, joking about it…

Paige: Connection, right? Connection…

Dr. Levine: Yeah. We need to move toward all these issues and take them on, raising our awareness, raising the awareness of people we care about. This can happen in a lot of different settings, and it is. I’m very optimistic about what’s going on recently Paige. There are more and more sports psychologists and trainers who are interested in how you can create athletic settings that are healthier. There are more dietitians, more psychologists, more social workers, more school personnel. I’m hoping...

Paige: I agree. I’m optimistic

Dr. Levine: I’m hoping that physicians, nurses...and I’m talking here about evidence based science as well as politics here, not just saying if we’d all feel better. I’m saying that, for instance, whenever anyone is told by a doctor or told by some by a dietitian, told by one of their friends, ‘You should go on this diet.’ I mean, I would like to see the dieting advice handled like a consent form for participation in research. Or I would like to see any dieting advice come with...

Paige: Warnings.

Dr. Levine: ...the ------------that comes with any medication that you have.

Paige: Side effects. (laughing)

Dr. Levine: Yes. What’s the probability that this is actually going to work. What it’s going to mean and what are some of the effects going to be--not just side effects. What are the multiple effects that you can anticipate and I think that what it would take to institute something like that, to raise awareness would be preventive and there is in fact some work like this going on in Massachusetts when it comes to food supplements and muscle building supplements and muscle building additives and things that people put in their food. There are a group of people, some of whom come from Harvard and academic settings working with legislators, working with nonprofit advocacy groups to try to get the laws changed in Massachusetts when it comes to what’s essentially an unregulated industry.

Paige: Yes.

Dr. Levine: These are not drugs and they’re not food. They are supplements, but we know they are far from harmless.

Paige: Yeah, that’s a big topic we could spend a lot of time talking about that one.

Dr. Levine: Yeah. So I’m not sure I’m answering your question here, but I’m...when a lot of people think of prevention, they think of school based curriculum and there is a lot of work going on currently in that area. But I would like people to think more broadly than just a school based curriculum.

Paige: You’re answering my question great.

Dr. Levine: There are a lot of organizations that are very broad based that have the potential to help make the changes you and I are talking about. For example, 4H. In Europe, and to some extent in the United States, but in Europe scouts and the scouting program.

Paige: Mhmm.

Dr. Levine: There are equestrian groups throughout the United States that could have an impact. There are church and youth groups. Because in many ways we’re talking about more positive values when it comes to respecting the body and respecting other people and being a good citizen and refraining from teasing and harassment...

Paige: Right, yeah.

Dr. Levine: ...and violation of people’s rights. To me, these are essential part of respect and valuing human beings and so on, are an essential part of most religions. So we could talk about it at that level. We could also talk about it at a civic level. A lot of people who listen are part of civic organizations, part of church organizations, part of youth groups, part of various programs and these programs often have a budget for public education, or a budget for meetings, or they recruit speakers for their annual dinners. This is where your listeners can become advocates for what we’re talking about. They can be a speaker of they can look for speakers.

Paige: I love these ideas! These are great!

Dr. Levine: Also in many communities, there are organizations--in the little town I was living in, Mr. Vernon, Ohio population 14,500--there are a lot of organizations like Rotary, Lions Club, Retired Teachers Association and so on, and they have a cause they support every year. It’s not a lot of money they can give, but it’s some. That money could go toward educational material for the schools, it could go toward materials and displays in the public library, it could toward perhaps a scholarship for a dietetic student who is interested in the kind of work we’re talking about here and they’re looking for causes and all people have to do is pick up the phone or get on a website or go to a meeting and say my name is Paige Smathers and I’m interested in this and I’d like to see your organization and you give a presentation. If nothing else, you’ve at least laid that out there for this group of people.

Paige: Yeah. These are great ideas. So you said something earlier that I wanted to circle back to because I’ve just been absorbing and loving everything you’ve been saying and I know that a lot of the things you’re saying I’ve thought about too and things I’ve been advocating for in my work as well. One of the things I get criticized about is...and I don’t want to offend anyone by this but a lot of people will say, ‘You’re just making excuses for fat people and you just’re just saying that you know it’s okay not to work on your health or not try.’ I want you to respond to that because I get that criticism all the time and that’s just something that’s...anyway I feel like we just need to talk about it in context of what you’ve said today and I want to make sure we’re hitting on that objection that people might be having in their heads.

Dr. Levine: And I would encourage anyone who feels that way or anyone who’s interested in responding to someone who feels that way to Google the phrase Health At Every Size.

Paige: We’ve talked about it a lot on this podcast.

Dr. Levine: Yes, HAES or Health At Every Size and that to me says, first health is the issue here at every size. So first of all, people come, if you will, in a wide diversity of sizes and shapes and skin color and heights and a wide variety of musical potential and a wide variety of intelligence. Biodiversity is a key aspect to the health of any population. Diversity is key. Secondly, the issue is health. How many more slender people do you know who are unhealthy because they smoke too many cigarettes, they drink too much alcohol, they don’t exercise, they have very unhealthy attitudes about weight and shape and body? So the issue is health; the issue is not size. Is it unhealthier to be overweight or fat than it is to be more slender? That’s one of those question that the answer to which is quite complicated. It’s probably, almost definitely unhealthy to be extremely obese. It’s also, as you know from your eating disorders work and as everybody knows it’s very unhealthy to be too slender. In between when it comes to BMIs for example, you know somewhere between 19 and 33 or 34 or 32, is probably not that clearly associated with a lot of different illnesses. It’s particularly true for women, not for men. What I’m saying is that no matter what your size and shape, you can get healthier. If the issue is health, what would you as a dietitian advise people to do to be healthier? You would advise them to be more active within reason.

Paige: Sure. I mean it depends on where there activity level is starting…

Dr. Levine: Yes…

Paige: ...sometimes it’s less active.

Dr. Levine: ..very good. It shows why you’re the clinician and I’m not.

Paige: (laughing)

Dr. Levine: So, in other words these are some basic things that you might advise people to do. One thing you might advise people to do is to be more self-accepting of their own bodies and weight and shape--back to the fact that self criticism and self shaming and treating your body as if it were a thing that needs to be pounded into submission is not going to be healthy.

Paige: It doesn’t usually lead to very healthy behaviors.

Dr. Levine: No. Most people are going to abandon that because it’s unpleasant.

Paige: Right.

Dr. Levine: You would advise them to choose their friends carefully adn to choose people who are going to be supportive and who are going to be there for you emotionally and be there for you and not going to run you down or tease you or criticize you or make jokes about your body and your weight and shape. These are things that would likely lead to greater health. Will people lose weight if they follow your advice? And as you know the answer is some people will lose weight, some people will lose a few pounds, some people will gain weight, but be healthier. If we start to focus on health we can get away from this simple notion that fatter is bad and thinner is better because there is no evidence that heavier, fatter people have more psychological problems than people who are thinner. There’s no evidence that by and large fatter people eat tons more than thinner people. There are some thin people who eat a lot and there are some fatter people who eat very little and their weight remains more or less the same. There’s no evidence that people can lose lots of weight and keep it off without of course adopting eating disordered attitudes.

Paige: Yeah. Exactly.

Dr. Levine: Anyone who says, ‘Well they ought to trade their obesity for a little bit of that anorexia; they’ll be better off, ‘ doesn’t know what he or she is talking about and really ought to examine their own prejudices and ought to examine…

Paige: A good way to sum that up Michael, is what we prescribe in fat people is what we diagnose in thin people, right.

Dr. Levine: Yes.

Paige: And there is something wrong with that picture. Why is it all the sudden pathologized if you’re thin and totally fine and normal if you’re fat. That to me is just completely inappropriate and so harmful and so taking a more weight neutral approach to your health and making it about feeling great and living a full whole life that you enjoy, including great food, including movement, including working on spirituality, including working on aspects of your life that make you feel whole and well. That’s the goal. And like you said, some people doing that will gain weight because they needed to. Some people doing those things will lose weight. Some people will stay the same. And our point in talking about Health At Every Size and talking about diverse body sizes is just to say, there’s no one right way to have a body and if we can learn to love and appreciate our bodies for what we are, it’ll probably be a whole lot more intuitive and easy to take good care of it and that’s not me saying, ‘Love your body thin.’ That’s just me saying it’s going to be a whole lot more natural to take good care of your body when it’s coming from a sense of, ‘I love it and want to take good care of it.’

Dr. Levine: I agree and I think that far too many people hear that when I say it--and I don’t say it as eloquently as you just did--they hear it as, ‘So you’re saying that I should just let myself go and somehow my brain will just take care of it.’ The answer of course is, it’s not an all or none matter. It’s not a matter again of total self-consciousness and self-control and self-criticism when you fail to live up to irrational standards. I mean to respect, to see again your body, to appreciate it, to care for it, is indeed to take better care of it.

Paige: Yes.

Dr. Levine: Evidence is pretty clear that heavier people, whether they’re obese or just heavier or heavier than they want to be, who feel very dissatisfied with their body and are very self-critical and run themselves down and allow others to run them down adn joke about it, they’re not motivated to take better care of themselves. They’re motivated to take less care of themselves. And anyone who like me has ever been depressed or anyone who’s ever been anxious and depressed, you don’t take better care of yourself under those circumstances. You don’t want to think about it. You don’t want to deal with it. If thinking about your health makes you feel bad, you don’t want to think about it.

Paige: Yeah, so true.

Dr. Levine: And how do you not think about it? Well you think about it by doing something else or you think about it by doing something that makes the pain go away and makes it go away soon.

Paige: And some people, that’s eating a lot (laughing) or restricting. That helps them numb that feeling.

Dr. Levine: And just have to ask...people just have to ask themselves in some way, ‘How’s this working for you?’ and ‘Is this how you want to bring up your daughter or your son? Do you want to take your mindset, take your feelings, take your struggles and pass them along to your son or daughter?’

Paige: No, you don’t.

Dr. Levine: Would the notion that it’s really up to you as a person, if you try hard enough, if you sacrifice enough, if you give it your all as a winner, you can do this. Is that the message we really want to pass along? Because of course, if it was a matter of saying, ‘You know Paige, you would be a more commanding speaker if you were four inches taller, so what you need to do is stretch your spine out by buying this product that you screw into your ceiling and then you hang from it for 15 minutes everyday and it will lengthen the muscle…’ I’ll give you some pseudo physiological explanation that you can believe or not and then I have a celebrity who says, ‘The ceiling hanger changed my life. I’m a new person.’ And they’ll show some trumped up before and after picture and, I mean you would say that’s crazy! I could injure myself! I have better things to do with my time! I know I need to make changes in my life, but they’re not going to happen hanging from the ceiling in pain as my shoulders hurt and stuff, and yet how much pain, how much self-criticism, how much self-shaming, how much guilt have so many people--particularly women--gone through over the last twenty years of their lives, the last ten years of their lives and how's that working out for us? Not just you as a person, but us as a culture.

Paige: Yeah.

Dr. Levine: That’s my question and I don't’ say it because ‘gosh women are silly and naive.’ I mean I would have given anything, Paige, when I was growing up, anything. I would have..if somebody said give me the little finger on your non-dominant hand--my right hand in the case--and if you do that, you could be Mickey Mantle. You could be the kind of athlete and baseball player, I would have given my little finger in a heartbeat. I would have given anything to be that person. It turned out that the person I wanted to be was a tremendous ballplayer but by his own admission was a very, very faulty, fallible human being, who drank too much and womanized and pissed away a fair amount of his...I mean this is not women are vulnerable to culture. We’re all vulnerable in some ways to different cultural kinds of messages. But there are far too many messages coming from far too many people in far too many channels that create a circumstance that makes it far too easy to develop a whole spectrum of eating disorders or disordered eating and eating disorders. And I do think that while it’s probably the case that a fair number of people develop eating disorders and there isn’t anything anyone could have done. That may well be the case. I refuse to believe that we couldn't cut down significantly on the number of new eating disorders in the same way that we’ve been able to cut down on the number of new cases of certain physical illnesses and the number of new cases of certain conditions. There are massive changes we could make as a society. It won’t be easy, but I think they’ll ultimately be better for all of us in this realm and others.

Paige: I love your ideas. I’m so glad to talk to you about prevention and to talk to you about...prevention is kind of a hard word because I think people have a certain idea in their mind of prevention of eating disorders--of what that means. But I really like the angle you take on it of it being both this really intensely personal and individual journey that each of us need to do and work on but also how can we affect our communities positively and how can we affect our families positively and you know that’s honestly a big goal of this podcast is to be a little bit of a different voice in people's ears of a different way, you know, then that kind of very socially accepted disordered eating type way. I’m so glad you came on the podcast to talk about your experiences and your passions and I know that we could keep talking forever. (laughing) There’s so much to say about these things.

Dr. Levine: You know I certainly could.

Paige: (laughing)

Dr. Levine: Umm, yes and if anyone is interested in prevention or has more to say about it or would like to communicate with me, I prefer email.

Paige: Okay, what’s your email address? I’ll link to it.

Dr. Levine: Yeah, it’s my last name

Paige: Okay, and then I also wanted to link to your colleagues research and story about the ballet school. What was her name again?

Dr. Levine: Her name is Niva Piran.

Paige: Great.

Dr. Levine: She is at the University of Toronto.

Paige: Okay. Great. Okay, well I want to just ask you a million more questions but I do want to let you go on with your day and with your weekend, so thanks again so much for talking with me Michael. I really appreciate it.

Dr. Levine: Pleasure. And if you’d like me to come back on the program at sometime in the future, I’m still young enough to think about it in those terms, so…

Paige: (laughing)

Dr. Levine: ...please feel free to get back in touch with me. I loved talking with you. It’d be no problem.

Paige: Great! Thank you so much!

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