Episode 11 Fat Phobia, Eating Disorders & Disparities in Health Care with Amy Rapone RD

May 03, 2021
 

What is it like to be a registered dietician in a fat body? In this episode Registered Dietitian Amy Rapone shares her experiences dealing with fat phobia as well as sharing her personal experiences with healthcare and working with eating disorders.

Amy Rapone, MS, RD, CDN is a registered dietitian in the state of Connecticut and owner of RadLove Nutrition, a virtual anti-diet private practice. She completed her undergraduate, dietetic internship and graduate work with the University of Saint Joseph in West Hartford, CT. She has dipped her toes in several aspects of the nutrition world, including school nutrition, education with low-income families, and clinical work in a community hospital. Part of her clinical work included working in a specialized eating disorder unit working in a team that helped patients with some of the most difficult cases in the country. She is passionate about providing care that is weight-inclusive, body and fat positive from a Health At Every Size® philosophy. 

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Transcript

CHRISTINE

Welcome to the podcast Amy. I'm so excited to talk to you today. 

 

AMY

Thank you so much for having me. It's very exciting to be here.  

 

CHRISTINE

I'm always interested to learn how someone gets into being a dietician. Was there something you were looking for when you decided to become a dietician? 

AMY

Sure. So I went to school as a business major first and hated it. So I left school for a while and then decided, gee, I really have never been happy with the size of my body but I'm not going to tell people that's why I'm going to go into nutrition. But I bet if I learn nutrition and I do the whole college thing with it that I can be skinny, again because I've lived in a fat body my entire life and of course had never been okay with it before. 

So I was already a married lady, so I was kind of a little outside of the normal college life by that time but certainly spent most of my college years and the first few years out of college becoming a dietician, going through my dietetic internship, still wanting to change my body. I think as time went on I definitely wanted to do that less. Especially once I became a mom. I think that that was the really big linchpin for me that, you know, I was okay, where we're in this. Now your body just did something freaking amazing. It grew a person and you birthed it and there it is. And from there I started to really get interested in what being in a larger sized body and being powerful in that really is and I found Christy Harrison's podcast,”Food Psych”, started listening to that religiously every week. I was on top of that and realized working in the inpatient hospital setting that I was in as well as doing some outpatient work with the hospital too, it really clicked for me that what I learned in school to help people was not working for them. And most of the time I ended up referring people out to mental health care alongside doing the work that I do, because there were so many other deeper things going on that were out of my scope of practice. And so through Christy's podcast, I really started to learn more about health at every size. I really started to pick that up and was frustrated in my current position and was very fortunate to be able to jump into working at an inpatient eating disorder unit, where health at every size is a little bit more accepted in the eating disorder field than in typical medical fields right now.

So I was very fortunate to be able to do that and loved my job so much. Until that unit unfortunately closed, um, due to hospital, uh, Issues that they no longer wanted. They didn't feel like it was supporting our community enough, which is unfortunate. So when that happened during the pandemic, of course, I, uh, started my own private practice to do weight inclusive nutrition care, and continue to working with eating disorders. And now I'm psyched to be doing it all the time. And now I can do it my own way, which is really nice. 

CHRISTINE

Yeah and really help more people because you mentioned that what was the common way of doing your work wasn't working. It wasn't working for people and you worked...was it your internship or your as well as a position that you were working with eating disorder care?

AMY

Eating disorder care I was actually kind of scared of it for a really long time. There's such a stigma around being able to help people with eating disorders and we don't learn much about it at all. Maybe we have a day that we learn about it and in my master's courses I did have a full course on it as well but because I signed up for it, not because of it being a requirement or anything like that. And I learned a little bit more, but still it was still scary. And the more I thought about it, the more I felt like I had the skills to be able to do that work and so it was scary, but I definitely made the jump and I was so glad that I did, because it was really the big part for me that changed my career because I was second guessing even being a dietician anymore. When I was kind of wondering if I was actually truly helping people or causing harm. I know I certainly wasn't helping myself anymore at that point. So I was having a lot of thought. So I was glad that I found an area of dietetics that I could actually thrive in. 

CHRISTINE

Yeah. It's interesting and very sad that eating disorders aren't covered in nutrition school. To hear that it's just a day, it's startling because so many people suffer from eating disorders and there is such a stigma. So it's very sad to hear that it's not something that's covered more.

AMY
It's incredibly sad. Especially, my years growing up in the recent age of fighting against childhood, "obesity" was pushed so much onto us for so long when really I feel like we've just made eating disorders for worse. And instead of focusing on eating disorder care at that time, which we could have really turned things around instead of focusing on that. So that's really where I struggle the most, even with my own children, because my first daughter is five now. And you know, she's going into school next year and it makes me super anxious to know what, what I'm going to have to combat as far as other kids and the things that they take in learning in school that are typical, you know, nationally recognized things that aren't super helpful that know can cause a lot of things as so many of my eating disorder, patients that I've had have told me, yeah, being weighed in school was like one of the biggest things that threw me off or having my weight read aloud or comparing myself to others in sports. And not just not being covered enough.
 
Christine
Yeah. There has to be a change in all that because it's doing so much harm and thinking about all the harm, starting at such a young age, like five or six years old, that kids are thinking about their weight. And it's just not, it's not good for their self-esteem. It's not good for their mental health. It's not helping them in any way. So there's definitely some things that maybe we can help destroy. Like you said, maybe we shouldn't be weighing our kids in school, reading aloud. That I can't even imagine. Is that still being done
now?
 
Amy
I sure hope not. And those are the things that I get so nervous about. And Lord knows I would write a real good letter, write a really good email or be knocking on the principals door if I hear that that happens. Um, some real change happens.
 
Christine
Yeah. I think we all should get on board with this change. If the listeners listening right now, if this is going on in your schools, the harm that can be done is lifelong for people that, I reflect on messaging that I received when I was young. And even you, when you mentioned the anxiety you have as a parent for your daughter because you, you know.
 
Amy
I know I lived through it. I lived through it and I know she's my kid, many women in our family are on the larger side, so I know that's likely going to be her body shape.
And so I want to make space for that for her and make sure that she feels okay and feels strong and owns it, you know? And that's really where my base and working in fat positivity really works for me because that's, you know, we're still worthy people in a fat body.
 
Christine
Absolutely for sure. So let's talk about eating disorders again, because you do work in this area, because there are disparities in the way people are treated and for those in particular with marginalized body. So can you talk about that and share that insight with our listeners?
 
Amy
Absolutely. Working in inpatient care really opened my eyes to that because it's not something I ever really thought about before. Working in a regular outpatient setting through the hospital, I didn't have a whole lot of eating disorder clients then but insurance coverage in the U S is pretty sad when it comes to covering nutrition services in general, especially if you are on a state insurance or a national insurance. There is not a whole lot of coverage and some only cover like three sessions a year. There's not a whole lot of change happening in that timeframe. When it comes to eating disorder care, insurance again, or lack of insurance for so many people, because so many are on disability because if their eating disorder is very acute, they're just not able to work a job and function in society like that. And it's really difficult to do any kind of work when you're not nourished. So when they're fighting against this mental illness, they don't often have the finances to cover really expensive insurance care and that's in any size body, nevermind when we are discussing the lack of screening when it comes to people who are in normal, straight size or larger bodies, because they don't expect that they would have an eating disorder because they look quote unquote okay or we're just prescribing them weight loss based on their looks without even asking what they're already doing which can further eating disorder issues or people in larger bodies just get labeled as having maybe a binge eating disorder, which isn't necessarily the case with,
there's so many people in larger bodies who have significant issues with anorexia and it's just not recognized. And it furthers their own thoughts about how unworthy they are for food.
 
Christine
So you mentioned something about binge eating disorder. I know this is an area of your expertise and possibly emotional eating.
 
Amy
Sure. I think we get the two confused. Oftentimes we consider, Oh, I've binged on a pint of Ben and Jerry's last night or, when we're just not feeling it, but there is a distinct difference. People binge for a lot of different reasons. Trauma can be one. It can be disparities, financial disparities or food access can cause a lot of binge eating issues as well, which is why sometimes it happens in people who aren't getting the coverage for the insurance. Like we would like them to for that kind of, uh, treatment anyway in addition to emotional things, emotional eating, is a little bit different and sometimes we want to make sure of the why behind while we're eating. That's the, that's the biggest thing that I always ask when people are saying, Oh, I binged like, okay, well how much was it? And what. What were you feeling about yourself? Because it's really the afterthoughts of the guilt, the shame, the, I shouldn't have done that. I'll restrict the rest of the day that can continue to cause this cycle. And when it comes to using food as a coping skill, because that's essentially what we're doing with emotional eating when we're having a bad day or we feel like we want to comfort with food. That's okay. Food is a nice, safe way to cope sometimes, but when it becomes your only coping skill, that's when we might be looking at something closer to a binge eating disorder where we're really just relying on food all the time as our only form of comfort and our only form of coping for whatever's going on.
 
Christine
Okay. So there's like almost like a sliding scale here, your emotional and your eating, but it could get really. That if, if it becomes like too much. So if you have clients that are emotionally eating, whether it be a bad day or because you work with people in this, in this area, what can you tell to a client that is maybe taking those steps and it's just one day, and then it turns into two, or you notice that it's becoming their coping mechanism, like you had mentioned what are some strategies that will help them. So that way they don't go into binge eating disorder.
 
Amy
Sure. And so there's a lot of different strategies. It's all very individualized, but my always number one first thing. And it's really, for most of my clients, no matter where they are at is to be following up with therapist or psychiatric care in some way. I'm a firm believer in therapy. I feel like I can only work within my own scope. And because when we are dealing with lack of coping skills or trauma or things like that, that's not something I can ever speak to. So I like to make sure that they have a safe therapist that they can speak to those things about and start to process those, build other coping skills so that we can start moving away from that. As far as the work that I do with them, we just kinda determine, meal patterns throughout the day. Making sure we're having some meals and some snacks. So because a lot of things that can also promote bingeing at the end of the day is pushing off, eating, pushing off, feeding, pushing off, eating, and then your body wants food. By the end of the day, you haven't done anything all day or you haven't done enough all day. And so your body's like, all right, let's go. We got food to eat. You know, I need to be able to function. So sometimes that cycle that can occur. So when we can bring it back and be like, okay, let's get those meal patterns set up. Let's make sure that each of those times is nourishing and adequate for you. You're being satisfied by those meals. And then, kind of one of the next pieces to the puzzle is focusing on our hunger and fullness cues. Those can be a little bit tricky for people if for whatever reason they're not connected to their body in some way, or if they've had a long history of restriction, those hormones that tell us when we're hungry and full aren't working quite as well as they could. If we were fully nourished and so those kind of take a little bit of time and I really try to stay away from the tracking of things like that, which when we're thinking about hunger and fullness cues, it's hard to not want to track with that, to know, okay, this is the okay time to eat. This is the not okay time to eat because sometimes it still is the okay time to eat. Even if you say you're not fully quote unquote, hungry, at this moment, or you're not starving, but knowing that there's a nuance there where it's a sliding scale of you may not be starving, but you can be hungry. So it's okay to have something and just kind of checking in a little bit more.
 
Christine
I like what you said about nuance. Because I think that there can be a lot of it's either this or this. It's so black and white, and there can be a lot of nuance, especially when you're dealing with, like you had mentioned trauma or any kind of disordered eating that you're not really in tuned with your cues. Like you had mentioned.
 
Amy
Yeah. And compassion and curiosity are my two, two C words that I like to use around this work, for sure. Because you have to have the compassion for yourself that it's maybe not going to be easy by any means, and it's not going to always feel like you want it to feel like it might be hard. And so having compassion and patience for yourself, and then the curiosity of trying something new and increasing the variety of things that you're comfortable with. Those are really the big ones that I try to focus on.
 
Christine
I love that compassion and curiosity. Those will be our C words.
 
Amy
Yes.
 
Christine
So let's talk about fat-phobia and health care. Because we were talking a little bit about healthcare and it really being flawed here in the U S as it might be flawed elsewhere in the world but we can only speak about our experiences here in the U S , so share with us your thoughts on the current healthcare system as well as  fat-phobia.
 
Amy
Sure. I we'll be upfront and say that, of course, as someone in a fat body I've experienced fat-phobia in medical care. I remember when I first went back to school, for actually it was right before I was working for an independent company who wanted to get me health insurance. Because I had just gone up to full-time and because I was the only one and because of my BMI at the time, I wasn't able to get insurance. They weren't going to cover me. Because that was before the affordable care act made that possible. She was very kind about it at the time and thought, I thought that she was the best ideas that she got me, a gym membership instead of paying for my insurance and. While I'm sure she felt like she was doing the right thing. I think that that definitely threw me into a loop of what my, what my worth was and then for years after the fact, still trying to get insurance and not being able to, because of my BMI at different places. So I went a long time without medical care because I couldn't afford it. I was in school, I was working low-paying jobs. So I decided that was okay. And there were probably things, I mean, I was young. I didn't have a whole lot of health issues going on at the time, so I didn't really consider it as an issue and then I got my job at the hospital. I was able to get full-time insurance and then my husband also was able to carry our insurance for some time through a larger corporation, but I still didn't go to the doctor and I think it all boiled down to every time I felt like I went, my weight got brought up, no matter how much I tried, no matter how much, I didn't want to be this weight because I knew what weight I was at. And I would try every diet in the book. I would do the workout routines. I would do everything and nothing was helping me get there. And actually it was pushing me into a higher weight because my metabolism kept changing and I'm sure other factors as well. So finally, when I got my hospital job, I was able to find a doctor who was incredibly respectful of my, um, you know, he knew me personally as well. And so he just kinda, he would kind of be like, I know you're a dietician. I know you know what you're doing. And he let me feel trusted in that, which was really nice. Unfortunately he left the practice, so I was unable to see him anymore. And I just recently, I've been hemming and hawing about finding a new doctor because I'm, you know, I work with doctors every day, so I'm really picky about who I, who I want to see. And I know too many now and I went to one who was in the same office because I had an ear infection and I knew I had an ear infection, but I wasn't going to be able to get antibiotics unless I did something about it. So I went and I saw her and she's like, you really should book a physical. And I was like, okay, I'll book my physical and I knew what the conversation was going to be when I booked the physical. Because she's like, I'm not really going to bring it up right now. Because you're here for an ear infection, but I want to bring it up. So you should really book your physical. And so I went to the physical and I made a point at this where I'm like, I'm so past, like my disordered eating any of that stuff. My head is in a whole different place now. Right. So I go there and she brings it up and I start bawling. I go, You don't even know how much I've gone through this and how unfair it feels that you are putting me in this box. I used to have binge-eating disorder. Well, I was never diagnosed with it, but I felt like I likely could have been at a time when I was in school. I went through all this. I am finally eating things that I like and in much smaller portions, because it just feels better to me. Like I know how to eat now and you're telling me that that's not okay. And I'm not okay with that. And so, yeah, it was really taken a back after that moment because I was like, Whoa, I thought we were way over this, Amy.
Um, but you know, it comes up still. And I think that I want to normalize that for people that it never truly goes away. And then, you know, she sat there with me and she listened and she was nodding, and she was like, I get it. And kind of commiserating with me on her own weight, which was a little strange and then she's like, I'm gonna, I'm going to show you this Instagram account. I think that you'll find it really motivating. And when she used the word motivating, I was like, Ugh, no. And it was an Australian shake company that showed before and after pictures, I was like, Oh my gosh, you don't get it at all at all. And I think of all the people that I see at the hospital on a regular basis that get judged by their weight because of their now chronic diseases that are oftentimes based on obesity, but I have to think how much of it is because a they don't want medical care, which is their autonomy to not want that. Instead of being labeled, as non-compliant people deserve to live their life, the way that they want to and be easily, could it have been caught or managed better if they weren't terrified to go to the doctor because the doctor focused on things that they didn't want to focus on or that they couldn't afford it because of their insurance, because they used to be in a higher body weight. So they weren't used to going to the doctor anymore. Even for my clients now it's so difficult. They are like, I just want to see a provider that's going to be safe for me. Like they don't have to be super safe. They just need to be like, I trust that you're working with a dietician. You know, I don't have to bring any of this up. I don't find any, I want, I feel badly for there to be providers where I can say, yeah, they're good. They're going to treat you with respect. They're going to ask you the right questions and they're going to help you work on your health the way that you want to, because ultimately that's what I think healthcare should be. I think that people should be given more of the autonomy of where their life is going to go and physicians shouldn't necessarily be the deciders in what's okay and what's not. But to provide options and provide informed decision to say, okay, this is what this is without a side of judgment, which I think is the part that we see the most.
 
Christine
Oh, my goodness. There is so, so much to unpack. There, there is so, so much , this is a real life example. And you even mentioned that you were in a better place when you were able to speak up. How many times do you not speak up? Because you're not in that better place. Right. And you don't, I would think that, you just don't go to the doctor. You even mentioned you weren't trying to get into that doctor's office, unless it was vital because you had that ear infection. So, how many people are not getting mammograms are not getting preventative health care that can save their lives? And like you had mentioned, like maybe, some of the issues that people have could have been prevented if they felt safe and too many in healthcare are, I mean, that's just crazy to think you don't feel safe and comfortable talking to. Someone that is supposed to be caring for
your health.
 
Amy
Absolutely. Yeah. All while increasing our stress levels about it, all which as we know is a factor towards our health. So, you know, it's, it seems like such a round robin that is, uh, just not serving us as, as humans.
 
Christine
No. I think our goal really needs to influence healthcare in a positive way. Definitely the doctor that you used to have. There has to be more of them. It's a needle in a haystack right now, but we have to find more, maybe doctors just coming into the field. I mean, Listeners, If you have doctors, we need them.
 
Amy
Yell their names on the mountain tops. We need them.
 
Christine
We need to know who these doctors are and help hopefully influence change in the doctors that are practicing these unsafe things. This the literally harmful harmful practices.
 
Amy
Absolutely.
 
Christine
Before we close out, I wanted to just ask you, what is it like being an RD? I know that for the most part, the typical RD is a thin white woman. So what is your experience being an RD in a fat body?
 
Amy
Yeah, I was the, one of the only ones in my class I assure you of that. As I was going through school, certainly probably the only one in the larger sized body that I was in. I consider myself in the super fat category of based on the different, I don't know who created it, but the different fat levels, I suppose. So certainly not very many, um, at all.
And still, I feel like puts me at a bit of an advantage because there are people who are looking for people who look like them to be providing more of that care. And certainly that goes to finding more Black and indigenous and Latina. Uh, well, I won't say Latino, we're a female led unfortunately, or fortunately a field, but, finding those who are of different identities are, or even Queer identities that can relate to people more so that they feel comfortable having these conversations and knowing that their provider has experienced it in some way, not that everyone's experience is the same, but I find that when I speak with so many of my clients, I go, yeah, I get it. Like I get that. I get feeling that way. And I think sometimes people just need to hear that, that they're not alone in feeling this way and it's okay. It's not okay that it's happening, but it's okay to have the feelings around it that you are. And sitting in that I think, Bri Campos of body image with Bri kind of coined this term of sitting in the suck of sometimes it just sucks. And until we have good change, you know, it's going to be that way. So we fortunately have to figure out our ways to cope with it. And I am grateful to be one of those people who can help people through that because I know I needed one and I wish I had that option.
 
Christine
Yeah, that representation is so important and I value what you're doing. I know our listeners value it and there's someone that's, that's probably looking you up right now. I'm going to put your information in our show notes so that way they can connect with you, , virtually since, we are now living in a virtual world now. So I like to ask all of our guests some simple questions just to connect a little bit. So what is your favorite way to move your body?
 
Amy
Um, it's actually something that I, um, Building back up right now.
I think since being a mom, movement, hasn't been on the top priority list for me. Um, but I've always loved to dance. Having dance parties is one of my favorite things to do in life, especially in my kitchen. And I've also taken up ax throwing lately. I can't wait to join a league when leagues are in because I have so much fun with that. I love that. Throwing heavy stuff around from my lifting days. So it's a nice lateral move over until I can get back up to lifting.
 
Christine
Yeah. And I think it's a good stress reliever too, rather than throw things at your kids, you throw the ax. Yeah. So what is your favorite way to practice Self-care?
 
Amy
my favorite way to practice self-care lately is reading. I still tend to not make enough time for that, but I, I find now that I'm a little bit older, I actually have the attention span for it, which I don't think I had when I was younger. Uh, and I love to continue to learn. It's one of my favorite things to do. And so I'm a bit of a non-fiction junkie, especially in the anti diet haze world. And we have so many amazing books coming out, In our field. So I'm lucky and excited to keep on reading them.
 
Christine
Yeah. And we have made a page on our website for reading lists for those that would like to add to that list, a book that you absolutely love. And like you said, there's a lot coming out. There's a lot that. Just our staples for us to read on intuitive eating on joyful movement, health at every size. So reading is definitely a great way to practice self-care and audible works too. You could always go on audible if you want to.
 
Amy
Yeah.
 
Christine
So 2020 created an opportunity for us all to binge watch or maybe binge listen or binge read  we had all this time that we were locked in our homes or, you know, away from being at work. We were on lockdown. So is there anything binge-worthy you re you recall from this past year that you'd like to share?
 
Amy
So it, it just came out this year but Wanda Vision. We are huge comic book fans in our home, and my daughter is actually named after an X-Men character. So we are, we're really in it. So when it comes to any kind of good quality comic book stuff out there we're into it. And Wanda Vision surely did not disappoint. It was wonderful. We were sitting at the edge of our seats every Friday, waiting for it.
 
Christine
Good to know. That'll go on my list. I'm pretty sure my husband watched it while I was watching Housewives or something stupid like that. So I'll make sure to go back and watch that. And then what's your favorite music. It could be a song, an artist, just the genre of music, because I know that you'd like to have your dance parties and your kitchen. Is there something that's getting you there, getting your dancing? 
 
Amy
I've recently found the blah-blah-blah and they're kind of like a mod retro poppy kind of, I don't even know how to describe it, but amazing Tthat's really getting me going. I really loved them and their lead singer, Ashley Levy is really awesome. And so I just really dig them lately. I love any kind of chic rock, you know, I'm a Joan Jett fan through and through and any of that, um, I'm really into.
 
Christine
I love all the suggestions that I get. We at Pop Fit Studio, are a music driven studio. So we like to use music for dance and our barre and our bounce and our boxing classes. And yeah, people often ask me, where do you get all these great music ideas. And it comes from, partly from this podcast because people like you share something that the blah-blah-blahs. I don't think I've ever heard of them and now they are going on my playlist. So thank you for that suggestion. And thank you so much for spending the time with me today and sharing with listeners, your story and your journey and the work that you're doing. I so appreciate you taking the time today and sharing.
 
Amy
Thank you so much for having me. It's been a blast.
 
Christine
So I'll be sharing, sharing all of Amy's information in our show notes and, and we'll be following and we'll be helping to destroy diet culture. Love it.
 
Amy
Let's do it.
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