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This week my guest is the fierce and wonderful president of HAES Australia, Dr Carolynne White! A Facebook post from Headspace in Hervey Bay fired her (and many others) up when it claimed that eating sugary food causes mental health problems! As a mental health expert and anti-diet advocate, Carolynne knows how much this kind of messaging oversimplifies, stigmatises, and downright does damage. The fact that the SUGAR IS EVIL message is being spruiked by one of Australia’s leading adolescent mental health organisations is a worry. Particularly when it’s part of “The Push Up Challenge”, a fund raiser for Headspace which raises awareness about youth suicide by forcing people to do over a hundred push ups a day. Has anyone at Headspace heard of eating disorders? Why is encouraging excessive exercise in teens ok? Do they know how hung up young people are about body image and health? WHAT ON EARTH ARE THEY THINKING!?

Join us as we rant about this extremely ill advised campaign. The truth is, mental health and physical health just can’t be separated, and we need to be doing a lot more critical thinking to avoid doing harm! CW: Discussions about suicide, mental illness & eating disorders.

Show Notes

My guest this week is Dr Carolynne White, occupational therapist and health promotion lecturer. Through her professional experience and her PhD research, Carolynne has formed the strong opinion that good mental health is absolutely necessary to support good overall health. Carolynne is also the president of HAES Australia.

• Carolynne got all fired up about a facebook post from Headspace at Hervey Bay in Queensland, about a ‘push up challenge’ to raise awareness about suicide and to raise money for Headspace.
• Headspace is a very well funded network of mental health treatment centres for adolescents and young people. Headspace enjoy a lot of government funding here in Australia, and also gather a lot of attention in the media. Their Mission is ‘to provide tailored and holistic mental health support to young people aged 12-25”. They focus on early intervention and prevention of mental illness, as well as focusing on physical health as well.
• According to the website, the ‘push up challenge’ was started by a ‘bunch of mates’ passionate about the topic. The challenge involves doing 3128 push ups over the month of August - one for each life lost to suicide in 2017.
• This is a LOT of push ups - over 100 a day. Louise’s first thought - why are headspace supporting an initiative that uses the symptoms of a major mental illness - ie the compulsive exercise aspects of an eating disorder - to raise awareness of mental illness? It just seems very ill advised.
• Particularly when you consider that eating disorder have the highest mortality rate, particularly from suicide, among young people.
• The man who started the push up challenge is Nick Hudson, he’s from Perth. He’s a white Aussie bloke in his thirties. Louise found 2 media articles about him which said slightly different things. One said he had heart surgery as a child, and when he got older his fitness declined and he realised he needed more heart surgery. This made him depressed, and one of the ways he came out of the depression was to start this push up challenge.
• But then another news article which came out about the same time (and was accompanied by a truly awful ‘Fitspo on steroids’ picture) said that his father had suffered from depression for many years but had never told him. When he discovered the depression, he ‘did some research’  on mental health. Then he and his mates, who do push ups as part of their regular fitness regime, decided to turn it into something more. So it’s odd to have 2 such different stories out there in the media, normally people have just one story, but there you go.
• There is a level of privilege reflected in the message that in order to come out of depression you need to do a few push ups. It’s great that this happened for him, but many people need a lot more help than just exercise to recover from something as complex as depression.
• Plus, particularly with people that Louise sees in her practice, the LAST thing they need is to focus on counting push ups!
• The Hervey Bay Headspace post was particularly problematic because he was posting about the evils of sugar as well. He claimed that high intakes of sugar increase the likelihood of developing mental illness, and more severe symptoms of depression. This of course caused a furore !
• Having worked in mental health, Carolynne thinks of the impact a message like this would have on an adolescent who might be struggling with their mental health, and how unhelpful it would be.
• The person who made this claim was a personal trainer, and obviously way outside of their scope of practice or expertise making claims like that.
• This post did attract a lot of push back from mental health experts. Particularly considering the vulnerability and age of the audience of Headspace!
• Australian teenagers are really hung up on issues of body image, health, etc, and we are seeing very high rates of eating disorder symptomatology which is being overlooked in this ‘health obsession epidemic’ that we’re all suffering from.
• The latest Mission Australia Youth Survey (2018) found that 30% of young people reported feeling ‘very’ or ‘extremely’ concerned about their mental health and their body image. These were equal concerns.
• Younger women reported higher levels of concern than younger men. Gender dynamics play into this. Thinking of a bloke modeling the push up challenge and the impact that might have on a teenage girl….
• A paper that has just come in in 2019 looks at the point prevalence of eating disorders in young people in Australia. Data from 5000 Aussie teens aged 11-19 showed that 22.2% met diagnostic criteria for an eating disorder. That’s 1 in 5 kids!
• 1 in 3 Aussie kids have high levels of concern about their body image and 1 in 5 have diagnosable eating disorders.
• In girls, the eating disorder rate is 33.3% and in boys it’s 12%. This is a huge concern and we need to centre this in our public health messaging.
• The push up challenge is an extreme fitness challenge. Looking through the Instagram for the push up challenge, a very narrow range (ie very muscular physiques) are represented. If we couple that with the facebook post which moralises food, it creates an environment which compromises recovery for those suffering with eating disorders.
• Are the people at Headspace really thinking this through?
• The Headspace demographic includes very young teenagers who are still very much black and white thinkers. If a 13 year old comes across the Hervey Bay page with its comments on sugar, they don’t have the cognitive capacity to see any nuance or think critically about it. This message is coming from an authority figure and they are highly likely to view it as: do not eat sugar under any circumstances.
• This is everywhere in Louise’s clinical practice at the moment: young kids developing eating disorders following exposure to well meaning messages about the nutritional value of food. Basically, no-one in high school should watch ‘That Sugar Film’.
• Adolescence is the THE highest risk time for development of an eating disorder. 14 years old is the average age kids can develop one. This is the exact demographic of Headspace’s audience and for these type of social media messages to be demonising sugar and pushing compulsive exercise, it’s really not on.
• Headspace have done a great job promoting themselves as a safe place for people with diverse identities to go. They need to incorporate body diversity into their messaging as well, many teens suffering from mental illness will be in larger bodies and need to feel safe and included.
• All of the eating disorder statistics from the paper on point prevalence we just discussed are higher in kids with higher body weights. People in larger bodies have eating disorders more often than smaller people, but if Headspace is full of gymbunnies doing workouts….hello!?
• Headspace’s own website discusses eating disorders & their symptoms, with sentences beginning with “Excessive exercise is a symptom of an eating disorder”…
•  The push up challenge has raised $2.5 million for Headspace, which is phenomenal. It’s a great job - but the methods of fund raising definitely need to be worked on!
• Headspace do a great job in our community, but they are well funded. There are 107 Headspace centres around the country. They get $95 million a year from the Government, and have just been given another $50 million. And when a psychologist at headspace sees a teenager, they bill Medicare for the appointment. Many of the psychologists are contractors, not employees of Headspace, so they take a % of the Medicare subsidised fee as payment.
• Headspace do great work, but they are well funded. In comparison we have a desperate shortage of hospital beds for people suffering from severe eating disorders. So many areas of mental health are severely underserviced. It seems that the ‘popular’ ideas get funded. So - if anyone listening wants to raise funds for mental health don’t give it to Headspace, they’re doing alright!
• This whole push up challenge for Headspace runs on the idea that exercise is always good for mental health. And there’s a real push in mental health to include ‘lifestyle’, or physical health.
• Carolynne started her career as an Occupational Therapist in a maximum security hospital - as did Louise! When Carolynne started, a report came out of Western Australia which found a huge disparity between physical health of people with mental illness and those without, and the gap in life expectancy.
• Working in a prison hospital, you see people from all walks of life. People who have experienced extreme poverty, severe trauma, and mental illness, and all of that mixed up together has a huge impact on their physical health.
• In the past few years there has been increased attention to the physical health status of people with mental illness.
• The National Mental Health Commission drafted up a consensus statement, and the stats are just astounding. In Australia, 1 in 5 people have a mental illness, and 16% of Australians live with both a physical health condition and a mental illness. If you have both, your life expectancy is reduced by 15.9 years for men and 12 years for women. This is conservative: around the world, the gap can be as much as 20 years.
• It’s staggering - much more than cigarette smoking.
• A few years ago Carolynne took part in Partners in Recovery, an initiative for people living with mental illness. During this period, 3 of the people involved died. Carolynne initially thought it might have been suicide. On of them had taken their own life, but one had a heart attack and the other died in their sleep of ‘natural causes’.
• This is the general case: People with a mental illness who die early, usually die from physical causes other than suicide.
• The main causes are cardiometabolic: heart disease, stroke, diabetes, and metabolic syndrome. All of the issues often attributed to higher weight.
• In the search to improve health and mortality outcomes, the focus has unfortunately of course landed on people’s weight.
• Because this is just what people with mental health issues need - a good push up!
• People with mental illness are more likely than the general population to have a BMI over 35. And that’s not to do with not eating the ‘right’ food or not getting enough exercise! A lot has to do with medication related weight gain.
• People taking medication to take care of their mental health is really positive, and if a side effect of that is weight gain, focusing on that and ‘blaming’ people for poor lifestyle habits is unfair.
• Antipsychotic medications, bipolar meds, and some antidepressant medications can have weight gain as a side effect. Many people Louise speak with could benefit a lot from medication, but often hesitate because of fear of weight gain. Or, people choosing to go off medication which is benefitting their mental health because of weight gain. This really brings home the reality of weight stigma. The drive for thinness in our culture is valued above everything else.
• Carolynne had an experience of gaining weight after being put on medication for depression, which she found confronting as she had previously lived in an always thin body.
• It’s very understandable, but it makes her sad, as in our culture people’s mental health might be compromised because of that societal pressure.
• Imagine if we lived in a truly weight inclusive society how the experience of mental illness might be very different?
• There’s already stigma around mental illness. If you’re going to lump weight stigma on top of that it just compounds the disadvantage that people experience.
• If someone gets well from taking medication, but then comes to live in a larger body, and experiences weight based discrimination, it’s yet another experience of oppression, exclusion, and marginalisation which is extremely weathering to physical and mental health.
• Many of the organisations that champion physical health don’t think about mental health whatsoever.
• So they don’t think about the impact of their campaigns on people’s mental health. The idea of perpetuating weight stigma and the health impacts of that (both physical and mental) - it’s just not thought of. Given the numbers of people suffering with mental illness, it is not ok that they are not considered in these campaigns.
• Particularly when you consider that people with mental illness are more likely to get these conditions, mental health should be people’s first consideration. The fact that they’re not is another example of entrenched stigma.
• They’re just erased, not visible anywhere. It’s depressing.
• This concept of the mind and body being separate goes back to the 16th century, with French Philosopher Descartes who championed the separation of the body from the mind. This is known as Dualism. This is where it all started but we need to get out of the 16th century and into the 2000’s!
• Mind and body are not separate, and physical and mental health are not separate either. It is super dangerous when we do.
• Carolynne & Louise first met at an Eating Disorders and Obesity Conference in the Goldcoast, where Carolynne got told off for being ‘irresponsible’ for talking about her non-diet community intervention, and Fiona Willer got pointed at and shouted down by Prof John Dixon. At the conference they had a presentation on the “Live Lighter” campaign. They had a speaker from the Cancer Council talking about the campaign, and a speaker from an eating disorders organisation talking about how they could change their messaging to make it more supportive for people with eating disorders.
• They used a slide with a stick figure with its’ head cut off, and then another with the head back on, to talk about how a combined approach - one that included mind and body - was much better!
• This is pretty naive when you consider that people with mental illness will get cancer at about the same rate as people in the general population, but are more likely to die earlier of cancer - because they’re not screened early enough, or their surgeries either don’t happen or are delayed.
• This separation between mind and body has deadly consequences.
• There is awareness growing that we need to do something to mend this separation. The Equally Well consensus statement is a good example of this.
• Equally Well is an initiative which started in New Zealand, as a collective effort to get people on board to improve the physical health of people with mental illness. Equally Well is very much led by people with lived experience of mental illness.
• In Australia, Equally Well launched in 2017, and many organisations have signed up in partnership with them. Earlier this year HAES Australia signed up. In terms of weight-neutral, non-diet content, Equally Well are not there yet, but we need to be in there in order to influence and give input, so that diet culture and weight centrism doesn’t sink its teeth in!
• The good news is, Equally Well is definitely NOT funded by Novo Nordisk, so there’s no Big Pharma agenda trying to sell weight loss drugs out of this!
• Caro Swanson is a champion of Equally Well and a person with lived experience of mental illness. Caro did a keynote speech at the first Equally Well Symposium in Melbourne earlier in 2019, alongside Helen Lockett (‘the other lady! - sorry!!).
• Caro spoke about her experience of having ‘experts’ come in and take away her power. She was worried that Equally Well would be just like other initiatives and leave people with lived experience out.
• Caro made the excellent point that people with mental illness are already under a lot of scrutiny, and with the introduction of physical health focus ‘now you’re going to scrutinise the rest of our lives too.’
• Carolynne gives the example of a man with schizophrenia living in a group home, who was being judged for eating chips and drinking Coke late at night. But this was the only food available for him to eat after a night shift. We must hold back judgements about people’s choices, and make the effort to understand their lives.
• Eating ‘well’ is actually a privilege, which not all of us have.
• Lots of people are doing the best they can to just eat regularly, and everyone needs to just back off!
• It’s really annoying to hear the story of the man with schizophrenia being judged for his food choices (which is really a judgement about his weight). Taking anti psychotic meds means he could eat kale morning, noon and night and still gain weight! It is not a ‘choice’ and the gain is not under his control. He is doing well to take his meds and strive for improved mental health.
• No-one enjoys hearing voices, it’s terrifying. If taking meds means increased weight, that needs to be ok.
• Caro made the excellent point “monthly girth measurements don’t do anything for my mental health’.
• Equally Well is a collective, lived-experience led, aimed at helping people living with mental illness improve their physical health in an equitable way. Caro’s stand against the weight-centric attitudes is awesome. We really need to ensure that things like waist measurements aren’t just blindly given for no reason: people need to give consent, and have the right to say no if focus on their weight is not comfortable for them.
• It’s great that HAES Australia are part of Equally Well, so we can really fight for a weight-neutral, inclusive approach to improving physical health for people with mental illness.
• One of the Equally Well statements says: “obesity is a major contributor to a range of common diseases including metabolic syndrome, diabetes, and cardiovascular disease. People living with mental illness should be offered tailored support for weight management programs as part of routine care”.
• It doesn’t matter how ‘tailored’ the program is, weight ‘management’ does not work!
• This approach just ‘ticks the box’, but we really need to apply critical thought. Why are we doing this - what’s the efficacy? If it doesn’t work in the general population to lose weight long term, why on earth would they work in those with mental illness who may suffer multiple barriers, be more disadvantaged and live more disruptive lives?
• In mental health over the past few years there has been increased focus on recovery and hope. Dieting approaches are the opposite of that! They disempower and get people stuck in an endless cycle.
• There are so many beautiful pathways to improving health that have bugger all to do with weight.
• Health professionals need a lot more training in mental health, particularly trauma informed mental health care and an understanding of concepts such as social justice and privilege.
• It is very important that our efforts to help people don’t traumatise them further.
• We need to really listen to people’s lived experiences, because everyone is unique.
• We can’t forget how much awful stuff has been done to people in the name of helping their mental health!
• I think weight management programs are our modern day equivalent of “One Flew Over The Cuckoo’s Nest” style therapy.
• Naomi Wolf said that dieting is a powerful political sedative.
• Maybe one day Equally Well can face off against Obesity Australia!
• Medication research needs to be done to improve the metabolic side effects, the answer is not to just add in another weight loss medication to the mix.
• Donate to Equally Well - they will definitely not have a push up challenge!
• Health is so much more than doing a push up.

Resources:

The Headspace Hervey Bay FB post which stirred controversy (scroll to July 10th)

HAES Australia website

Dr Carolynne White’s research profile on the Swinburne University page.

The Perth article which talked about Nick Hudson and his reasons to do The Push Up Challenge where he talked about his heart operations.

The Triple White article which talked about Nick Hudson & his dad’s depression being the inspiration behind the Push Up Challenge (get a load of the extreme Fitspo image they chose to use…)

The Push Up Challenge website

The Mission Australia Youth Survey 2018

The Headspace website

Details on Headspace funding

The Lancet paper on the physical health of people with mental illness

The eating disorder point prevalence in Australian adolescents paper

The Equally Well Consensus statement

An awesome interview with Caro Swanson and Helen Lockett. From Equally Well.

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