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The (Long) Road to My PhD Study

by Lily O’Hara, BSc, Postgrad Dip Hlth Prom, MPH, PhD (c)

I have recently submitted my PhD thesis in public health and health promotion, and as part of the process, I was reflecting on my position as a researcher and how I came to that position. I realised that the road leading to the study was in fact a very long one, and started when I was a young girl.

My first conscious interest in the issues of weight and health began as an 11 year old when my family moved from a farm in a small rural district in northeastern Australia to an urban coastal area. Within no time at all, it became apparent to me that the “surfie chicks” were the queen bees of the social hive and that their small, tanned bodies and bleached blonde hair constituted the ”ideal” look. I was not small (though in looking back at old photos it is clear I wasn’t fat either), I had fair skin and brown hair. At the age of 11, I started dieting, tanning and dyeing my hair. The pull of fitting in, belonging and shedding the “fat, white freak” label was very strong for me, despite having loving and unconditionally accepting parents. But this was the 1970s and no one really knew then about how harmful it was to diet and sun bake, so I was pretty much allowed to get on with both.

The Israeli Army Diet was my first real diet and I think I lasted less than a week before breaking out of the strict confines of food regulation and deprivation. I had lost a bit of weight, of course, but it came back in no time, and brought some more with it. Although I was very active, and played multiple sports throughout my high school years, the pattern repeated with each diet ending and a little more weight arriving. The same story continued at university, and whilst I was a confident and self assured young woman, who relished my strength, stamina and speed in football (soccer), basketball and rowing, I still hated the way my body looked. Being strong and fit and fast wasn’t enough: I wanted to be thin. Being selected for city level, regional and state representative football teams wasn’t enough: I wanted to be thin. Being selected for the Australian Universities football team wasn’t enough: I wanted to be thin. It didn’t dominate my entire life, but it was an ever present nagging desire.

One of my early professional jobs was as manager of a small private clinic called Bad Habits (I still cringe at the name) that provided a range of programs to help individuals break their “bad habits.” I received some cursory training in health counselling and was let loose on an unsuspecting clientele desperate for help with their “intransigent” behaviours. The service in greatest demand was weight loss and so I spent a significant amount of my lengthy working days talking to people about weight loss goals and strategies. I was slim at the time and in a position to parlay my private obsession with body weight into a legitimate professional obsession. Most of my clients would lose weight in the short term, and if they didn’t, we would examine what they were doing “wrong” and how they could do “better.” Although I was still firmly of the opinion that their body weight (and smoking for that matter) were their own responsibility, I began to become aware of the damage to self esteem and self confidence when they had “failed to comply” with their diet plans and returned to the centre having regained all the weight they’d lost. Their sense of shame and internalised self-blame was palpable. A little tiny part of my brain started to question the benefits of this all-consuming focus on weight loss and indeed the efficacy of the very programs I was implementing with clients. But it was only a tiny part, and although it added to the small glimpses of insight from previous experiences, it was still not enough to cause a revolution in my thinking.

A short time later, I acquired a boyfriend who was very focused on the way his body looked, and mine, and I started to become more fanatical about it too. I added compulsive exercising and routine vomiting to my toolbox of weight loss strategies. I had toyed with both previously, but in this relationship I really got serious about them. By then, I had moved on to working with a large non-Government organisation and enrolled in a Postgraduate Diploma in Health Promotion. As I learnt about the determinants of health and individual behaviours, I started to rethink many of the assumptions I had made previously about people and their “bad habits.”

My growing professional knowledge about the roles of inequity, society, culture and environmental factors in determining health status were completely dissonant with my own inner beliefs about the determinants of body weight. I craved thinness more than ever and stepped up my weight loss behaviours to try and achieve it. I was receiving huge amounts of positive feedback from others about how slim I was and how great I looked.

It didn’t work out with my fat-phobic boyfriend and after the breakup, I descended into even more extreme disordered eating and exercising. After some time, I started to realise that all of this was starting to make me sick. Not physically sick – I was still extremely fit and playing representative football at the time – but mentally unbalanced. I became entirely self focused, and felt my compassion for others draining away in the unending quest to control my body. The culminating point for me was the wedding of one of my best friends, where I had been given the incredible privilege of being a bridesmaid, but all I could think about was how fat I looked in the apricot taffeta dress, despite the fact I was the thinnest I had ever been. I was so totally self absorbed that I couldn’t even focus on my friend’s happiness.

If any good came from this episode, it was the realisation that something had to give. For purely emotional  reasons (my heart wasn’t in it anymore), I declined the opportunity to play state level representative football, though I kept playing club and regional level because that was more fun. The upside to this decision was that my punishing exercise routine started to subside, and so did the vomiting. I slowly started to heal, but the journey back to wellbeing was not that easy. As I inevitably gained back some weight, my concerns about my body resurfaced, but this time they didn’t dominate me. After some time, I started a new relationship with a man who was much more body-friendly and who made me laugh at everything, including myself. I also started to read about issues like body image, and after soaking up Naomi Wolf’s The Beauty Myth, I saw for the first time the political and cultural contexts that helped to spawn my body hatred. I really started to challenge the fat=bad mantra that I’d embraced so wholeheartedly for the previous 20 years.

Fast forward another 20 years and I now have three daughters. Being responsible for their precious lives has intensified my desire to make the world a safer place for them and for their bodies. Our home is a fiercely weight-neutral and fat positive zone, and I take every opportunity I can to help them critique the dominant culture that idealises thin bodies and model the Health at Every Size® and Respect at any Size approaches. However, I cannot protect them from their culture, nor would I wish to deny them the opportunity to develop their own learning. But it is a painful experience to witness your own daughters wrestle with the same anxieties and dissatisfaction with their bodies that I have worked so long and so hard to overcome with mine.

As a health promotion practitioner and academic for over 25 years, I have long felt uncomfortable about the dominance of the weight centred health paradigm in public health policy and programs. I am particularly concerned about the harms done to people in the name of “health”, and indeed about the harms that I have inadvertantly inflicted on people both personally and professionally as a result of my historical investment in the concept of the “ideal” body. I am also concerned about the ineffectiveness of weight centred health promotion policies and programs, and feel that the time, energy and financial resources committed to fighting this war on fatness could be better spent addressing issues that really impact on the health and wellbeing of people, like poverty and injustice. And finally, I am annoyed about the willful misrepresentation of the evidence about body weight and health, particularly by my scientific colleagues. As someone with training in the scientific disciplines of zoology, parasitology, health promotion, epidemiology and biostatistics, and therefore comfortable with complex and often contradictory scientific evidence, I am deeply vexed about the simplisitic, inaccurate and exaggerated representations of body weight and health that are promulgated about body weight. These factors have led me to think about issues from a human rights perspective, and the extent to which the actions resulting from the weight centred health paradigm violate the human rights of fat people in particular. They have also led me to question the role of my own professional discipline of health promotion in perpetuating the weight centred health paradigm. The experiences described here (and untold others) have been instrumental in shaping my personal and professional beliefs about body weight and health and therefore the position from which I undertook my PhD study. It has indeed been a very long and rocky road from surfie chick wannabe to a critical discourse analysis of the extent to which weight-related public health initiatives reflect the values and principles of good health promotion practice.

Lily O'Hara_3

Lily O’Hara, BSc, Postgrad Dip Hlth Prom, MPH, PhD (c)  is passionate about social justice and the need for health promotion to be truly health promoting. Lily has worked in health promotion positions with government, non-government, university, private and community organisations for over 25 years. Lily has most recently worked as the Section Head for Health Promotion with the Health Authority – Abu Dhabi. Prior to that she spent 13 years as an academic at the University of the Sunshine Coast, Australia, where she established, taught in and led the health promotion and public health undergraduate and graduate programs. She and a colleague have developed and tested a new model of health promotion called the Red Lotus Health Promotion Model, which is the first health promotion model to explicitly incorporate a system of values and principles. Lily has held leadership roles in a number of scientific associations including the Australian Health Promotion Association (National President) and the Association for Size Diversity and Health (International Vice President). And a recipient of  the National Association to Advance Fat Acceptance International Size Acceptance Trailblazer Award for diligent work in bringing  the HAES® message to colleagues in the health education field.

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