Author: Caitlin Hildebrand, MSHAIL, MSN, AGPCNP-BC, NP
Body positivity. Many experts in this field say it’s too difficult a goal; some suggest body neutrality is more feasible. I disagree. I think we are all bombarded with negative messaging about how our bodies should be (from others and ourselves), and we need to counter that negativity with positivity. Only then can we have less destructive thoughts and behaviors. It is like electricity. We cannot change a negative charge without a positive charge. How do we do that? How do we act in a positive way towards our bodies and, therefore, ourselves? I think body-loving-kindness is the answer.
Loving-kindness is a cornerstone of all mindfulness practices. In mindfulness, from the perspective of leaders such as Jon Kabat-Zinn, we are called to pay attention to the present moment, while decreasing judgment and increasing loving-kindness or compassion. Therefore, practicing body-loving-kindness is about listening to and honoring our bodies’ signals, at this moment, while decreasing harsh thoughts, and holding ourselves with more compassion. The most powerful part is in noticing the judgment and countering it with compassion.
So how do we change our thinking?.
First, it means working towards appreciating your body for what it does for you, rather than what it looks like -- which is the default mode of Diet Culture. Appreciating your body as an instrument, not an ornament, worthy of kindness no matter the size, color, gender, age, or ability. Notice I say “working towards” as a way to recognize that this is a process, and we will likely never feel or think entirely positively. What matters is how we counter the judgment from ourselves and from others.
(Trigger warning: I will be sharing about my eating disorder. Please skip the next paragraph if that feels too raw to read right now).
I have struggled with body image since I was nine. I went through puberty younger than most, and other children poked fun at my curvier physique. As a ballerina, I was taught that my worth was measured not just by my skill, but by how I looked, and that I should be as lean as possible, no matter the cost.
In addition, I came from a family obsessed with weight and dieting. It was a petri dish for eating disorders. In the years that followed, I struggled with anorexia and then bulimia. Never enough to get me hospitalized, but enough that I knew I was suffering and wanted to heal. I just wasn’t sure how. I knew my thinking was distorted. I never felt good enough. No matter my size, I was harsh and critical of myself. By about 25, I realized that I wanted to stop obsessing over food and weight and making myself throw up when I overate. Vomiting jalapenos through my nose was a wake-up call that what I was doing was clearly not serving me. I began speaking with a therapist and realized that I was piling on shame when I vomited. It did not relieve anxiety about food or my body; it just made it worse. I began to heal.
Over time, I combined knowledge about health, which I gained as a Nurse Practitioner, with a desire to be loving to myself. I began to eat not just for fuel, but also for joy, without reservation. I developed close relationships with people who valued me not for what I looked like, but for who I was. In the years since, I have fluctuated in weight, but I have never reverted to the same level of negative self-talk that I had in those years of disordered eating. However, I would be lying if I said those thoughts didn’t come.
What has changed is my ability to notice and counter-balance them with a more constructive perspective. With mindfulness, we practice noticing our thoughts rather than believing them to be true. Mindfulness suggests we ask ourselves: “Is it true?, Is it kind?, Is it necessary?”. We make space for observation, separating ourselves from the thought and seeing if it serves us. We don’t necessarily rid the mind of negative thinking but can choose to counter the negative with the positive. That is how body positivity can transform our lives.
When a negative thought about my body comes up now, I notice it and question it, in a number of ways. I can say, “I have gained 40 pounds since COVID, but who cares? Not anyone who really matters.” Or “I have gained 40 pounds since COVID, and I am still healthy. My blood sugar, blood pressure, and cholesterol are great. That is what matters.” Or, “I have gained 40 pounds since COVID, but my value does not depend on my weight.” All these thoughts are true, kind, and, at least for my mental health, necessary.
What about when our bodies are not so healthy? As an Integrative Nurse Practitioner practicing the Health at Every Size approach, I teach that what matters is not weight or size, but clinical cardiometabolic indicators, which vary dramatically. Low-weight people can have very poor cardiometabolic health, and people with bigger bodies can indeed be vibrantly well. But what about when they are not? Or are they at risk? How do we approach body positivity then? Should we just say, “Screw it! My body is what it is!” Or do we seek to become healthier? How do we do that without allowing negative self-talk to win?
I think it comes down to discernment rather than judgment. Discernment is thoughtful reflection and assessment without criticism. It allows for considering change without being judgmental about our bodies and ourselves. In teaching mindful eating to veterans, who often deeply value discipline, I teach them to think of discipline not as following rules or deserving punishment, but instead to follow the root of the word discipline - student. We work on developing a kind curiosity about our choices, listening to our bodies, and learning from ourselves. In this way, we can make mindful conscious decisions about how to be kind to our bodies and give them what they really need -- not what we have told ourselves they need, which is often based on culture, fads, sexism, racism, and internalized fat phobia.
So, how do we do this? How can any of us do this while addressing very real health concerns? How can we do it without judgment and self-criticism? First, we must let go of the harsh idea that any one choice is problematic. One candy bar. One croissant. One meal where we overeat. None of these determine health. What matters is patterns. Patterns of behavior. Conversely, small choices do add up. Adding more veggies at each meal. Making sure to stay hydrated. Consistently honoring hunger and fullness, and really checking in with what the body needs.
Don’t get me wrong. I am not suggesting mindful and intuitive eating are for weight loss. They are so much more and should never be reduced to a new trendy way to diet. Indeed, mindful and intuitive eating are the anti-diet. They are a belief system that says you can honor your body’s signals, and care for yourself in the way it asks you to; that you should not change yourself to meet others’ standards. Body positivity as body-loving-kindness is not a noun, but a verb. A way of behaving that is positive towards our bodies and ourselves. It is therefore not about loving your body, exactly how it is, (which for many of us is unrealistic and therefore not very actionable), but instead being loving towards our bodies and ourselves as we are right now.
How do we do that? How do I? Often, it may mean advocating for yourself when others are judging your body and your choices. For example, I was considering breast reduction surgery, due to chronic neck and upper back pain. In order to have the surgery, the clinicians told me I must lose weight. They looked solely at my weight and considered me to be at elevated risk. As someone who constantly teaches about Health at Every Size, I have felt angry and resentful about this approach. I emphasized to my clinicians that all my cardiometabolic data shows I am exceptionally healthy, and that with a history of an eating disorder, I did not want to risk relapsing into destructive behaviors. Still, they sent me links to weight-loss groups and nutritional information that were far below my learning level as a healthcare provider.
I decided to stand up for myself. I wrote to them and asserted that I know that as someone with an eating disorder history and very healthy clinical indicators, I am better served by working to accept my curvy body than to accept their definition of what health looks like. I was upset that it meant I would not have surgery, but I also knew that I didn’t want to have a procedure done by people with a narrow and superficial definition of health. Even as a clinician, I felt a bit nervous disagreeing with their assessment, but I knew it was the most loving, kind, and compassionate way to move forward.
I was surprised and pleased when my doctor then called me. He knew he had hurt me and wanted to apologize. He said he was sorry to have not paid attention to the risk my eating disorder posed and would do better in the future. He said he would learn more about the Health at Every Size perspective and that he agreed that I was indeed not at significant surgical risk. He encouraged me to advocate for myself with the surgeon. Still, it was too late. I felt demoralized by how I had been treated, and I felt a renewed intention to work to accept myself as I am and to manage my chronic pain in other ways.
So here I am, working on being loving to myself as I am, right now, just like you. As someone who has been teaching mindfulness and mindful eating for years now, I am still a work in progress and always will be. In fact, I think that is what helps me connect with the veterans and others who I teach. We are all in this together. Working to use discernment to stand up to judgment from ourselves and from others. Rebelling against destructive standards and beliefs. Considering discipline as a way of learning from ourselves and asking ourselves what we really need. Body positivity as body loving-kindness is a way to liberate ourselves from the beliefs that limit us. To create real freedom from within.
Caitlin Hildebrand, MSHAIL, MSN, AGPCNP-BC, Nurse Practitioner, RYT500, is Clinic Director in Integrative Health at the San Francisco VA, where she practices Integrative Medicine and Primary Care, teaches yoga and mindfulness, and developed and leads a Mindful and Intuitive Eating program for veterans and staff.
NP Hildebrand began her career in inpatient psychiatric nursing, including on eating disorders units. She has taught
for numerous healthcare organizations and conferences throughout the US, and published the book "Un-Less: Mindful Journaling for Body Positivity, Mindfulness and Unconditional Self Love". She has a breadth of knowledge in health and wellness, with a Medical
Fellowship from the Weil Center for Integrative Medicine at the University of Arizona, Bachelors' degrees in Psychology and Nursing, from Swarthmore College and University of Pennsylvania, Masters in Nursing and Healthcare Administration from University of
Pennsylvania and UCSF, is a PhD candidate at the University of Colorado in Veteran and Military Healthcare, and is an assistant Clinical Professor for UCSF.
She graduated with a Yoga Alliance Certification from Yoga to the People and Holistic Yoga Coach training from Purusha Yoga School. She also completed group facilitator training from the Center for Mind-Body Medicine and UCSD Center for Mindfulness, and coursework in trauma focused yoga from Veterans Yoga Project, Inversions at Baptiste Yoga and Yoga for Grief at The Center, all in San Francisco.
She lives in the San Francisco Bay Area, near the Russian River, with her husband and cat, under the redwoods.
You can find more about her in her webpage: Hom Heaven Health