Season 3, Episode 13: Why Weight Loss Isn’t Always The Solution

Welcome back to The Gut Show! Today you are in for a treat because we have special guest Shana Spence. Shana is a Registered Dietitian Nutritionist based out of New York, but you can find her online @thenutritiontea spreading the word about non diet approaches to healthcare as well as the Health at Every Size movement. She is such a trailblazer in our field, and in this episode, we're talking a little bit more about what Health at Every Size means, what to do if weight has been the central focus and approach in your healthcare and your health plans and how to advocate for yourself for more high quality care and to get involved in this movement in order to have more inclusive and quality care overall for our entire population.

Enjoy today's episode, connect with Shana afterwards through social media and they connect with us in The Gut Community to share your thoughts questions and dive deeper into the conversation.

Today’s episode is sponsored by Seed. Their signature product, the DS-01™ Daily Synbiotic, is a combination of science-backed probiotic strains and prebiotics that work in synergy to promote healthy digestion, ease of bloating, glowing skin, and more. You can learn more about Seed and the Daily Synbiotic at www.seed.com. Use my code erinjudge15 for 15% off your first month's supply.

Erin Judge: Shana, thank you so much for coming onto the show today! I want to get started by just learning more about you, so tell me a little bit about yourself, and why you decided to get into nutrition and the disordered eating path.

Shana Spence: So I began my career actually in fashion. So I used to work in that industry for about eight to nine years. And then I switched over to nutrition, I became just super interested in like, public policy and the public health side, especially here in New York. And so that was kind of my goal going in, just like learning about the disparities, and kind of how to deal with that and then, you know, I went to school, did the whole thing of taking the exam, and you know, internship and all that, and I actually now currently work for Department of Health. But I didn't get into like, the anti diet/HAES like disordered eating that came after kind of learning about that aspect, really through social media. I know we always complain about social media, but I think sometimes it's just a really great learning tool as well, and that's sort of where I became interested in that sort of aspect. So it's kind of nice to combine both worlds.

Erin Judge: That's awesome, I had no idea! So I met you through social media, I didn’t know that you had a background in in fashion or that was the route that you came, which is such an interesting overlap! Was it through your work in fashion that you became aware of disparities, was it because of the area that you lived in or what really connected that and brought that connection to the forefront?

Shana Spence: It was more so the area that I just grew up in. I was just reading, you know, you kind of hear about things and, you know, in fashion, it's a fine industry for some, but, you know, I was kind of getting the feeling like I wasn't contributing much, it wasn't for me, really. And I have friends who still work there, so it's not the industry, it's just like, the individual. Because it is very…..it's intense, I'll just put it that way.

I just started noticing different things happening in like the area I grew up in, and then kind of moving back to that area, because there's a lot of, I mean, yes, across the country, but definitely in New York, I don't think people realize, like, how much of a discrepancy there is just because I think New York has the reputation of being like this melting pot of diversity, which is, but I don't think people realize like, there's so much discrepancy between between folks. So that just was an interesting thing for me, and so now working with Department of Health, kind of just figuring things out, has given more insight for sure.

Erin Judge: That's awesome. And you grew up in New York?

Shana Spence: Yes, I'm from Brooklyn.

Erin Judge: Okay. Wow, that's interesting. I'm from a small town in south Arkansas, so pretty much the opposite of New York City, very small, 1000 people, probably one little like, tiny street in New York. But also, it's interesting to see the health discrepancies there, just how discrepancies within health and I worked in public health too, but how that's so unique, and that it can be present in New York City where, you know, people are commuting more, and like, there might be more of a population in a small area and you know, there may actually be a grocery store, but that doesn't necessarily mean that there's still not a discrepancy present. And then you look at places like where I grew up, like very rural, you know, small town where there's not a grocery store, you have to drive a long way, there's no commuting, right, you drive everywhere, you don't walk anywhere, because you would never be able to get to your job or where you're going. But it's still present in all those different places and it’s interesting to think about that.

So now you speak a lot on the Health at Every Size approach, you speak on the anti diet piece. And you mentioned that that came out through social media, how does that actually influence your work now in the Health Department? Is that something that you find is at the core of some of the work that you're doing and some of those problems you're trying to solve? Or just kind of where is that connecting now?

Shana Spence: It's hard because I try as much to kind of intersect the two but, you know, when you work for the city and state, you know, government just put it that way, you know, it's a little bit hard because we definitely do a lot of focus on like BMI and that sort of thing. So it's not the easiest, like, I can't just say, well, I'm not going to do that, but I can, luckily I do have a supervisor who is open to hearing those things. So it really, you know, there's not much room to kind of do your own thing, but at the same time, I'm lucky to have a supervisor who's like, yes, we can try to see if we can like do things differently. Just because what I do is a lot of community work, going into different communities and talking about nutrition, of course, but now I was kind of given the go ahead, like, yeah, we don't have to kind of emphasize like, all those “O” words like obesity, and you know, all of that, we can try to focus on the actual nutrition, which has been nice. But like I said, it's very individual, like, not everyone can do that, just want to put it out there.

Erin Judge: No, no, I get it. We will get into like, the whole diet culture and all this piece, it is so deeply rooted in our society and in our culture and I think what a lot of people don't understand is that it is so deep in our government. I used to work for the WIC program, we had to take weight, you had to take BMI, we had to track weight. If a child was gaining too much weight, like there were certain educations we had to give, and it was all required in order for our families to get their checks or their card, you know, they had to go through all of that. You can see it when you're inside of it, how it's a problem. And then it also feels like, well, am I perpetuating this and making it worse? And then how do I, you know, do that and fulfill that need, because it's needed for the research and the outcomes, you know, and all of that stuff, because we haven't gotten creative yet. But it's also not the main focus or the value versus like, nutrient quality and, you know, quality of life and other resources and so many other things that mattered more than, you know, whether a kid has gained a certain amount of weight.

Shana Spence: Exactly, there's so many other determinants right, like the social determinants. And, you know, I think it would be more plausible to focus on those things but, you know, we do what we can, you know, so

Erin Judge: I think it is starting to change, because voices like yours are in there, and that is the way to change. And we'll definitely get into that because I do think there's some pieces to all of this, that, you know, there's some personal tools that, you know, listeners we can use, if we're experiencing some of the language we're going to talk about, there's also things just as a population, you know, as a human race that we can all do, whether we experienced it personally or not, that we can do to help try to change what's going on. And if you have those resources, we'll talk through those. I think it will help because the whole idea of Health at Every Size, anti diet, anti weight focused health care is something that's a bit confusing to people on social media, there's so many sides to it, that, you know, when we break it down, it makes sense. But then there's also so many voices that are against it, or just completely misunderstanding it. I'd love for you to break down what Health at Every Size actually means, and why it's so important that we start moving towards that approach.

Shana Spence: Yes, there's so much confusion. And it's kind of interesting, because like you said, I think there's so many sides to it, where there folks who like will say yeah, no, I don't want people to be stigmatized, but they'll use stigmatizing language. So I think it's actually important to start there, you know, with Health at Every Size, the whole purpose is that we're saying that it's not okay to stigmatize a group of people, which I mean, on paper, it's like, yes, but for some reason, it's kind of accepted to have these like clinics of like diagnosing people, like why do you look this way? It's just like, okay, that's not okay. So I think that's a good place to start.

Health at Every Size is really just taking a non weight centric approach, meaning that we can actually provide nutrition intervention, nutrition therapy, or any sort of health related things that someone needs without focusing on the scale or without focusing on numbers in general, you know, it's possible to help someone who is diagnosed with diabetes or like IBS, or you know, anything like that, but you don't have to constantly weigh someone, you can focus on health behaviors, such as eating, how they're sleeping, all of these things. So I think it's just like a super important movement in my opinion because telling someone constantly well, you need to lose weight, that's not helpful. Because we know that folks of all sizes have diabetes, and you know, IBS, or you know, heart disease, so why are we focusing on weight with certain populations? I think that's the general gist of it but I think the stigmatizing language is the part that a lot of people leave out, because I do notice that whenever I hear of obesity, doctors talking, they're like, yeah, no, we want to make everyone feel like not stigmatized, but they're calling themselves obesity, like doctors or, you know, so it's just like, okay, you can't do both. So that's the thing I think that most people don't realize.

Erin Judge: Yeah, that's helpful. It's helpful to break that down and see that and I think one misconception that I've seen just in hearing people talk about it and, you know, I think that we are technically a Health at Every Size practitioners, we don't consider ourselves like certified health every size practitioners on weight, honestly, I've never wanted to, it's like to me, it just doesn't make sense of like, well, okay fine, obviously, if you're rapidly losing or rapidly gaining, it's not about the weigh-in at that point, it's about what's going on in your body, like what exactly, eating, and that's important, but just focusing on weight doesn't actually provide value versus all of the other pieces of information that we can get.

What are some of those stigmatizing language pieces that you see, especially among providers that even among people who are living with conditions that they might take on and use themselves and, you know, on social media and things like that? What are some of those examples?

Shana Spence: I think just, and that's why I call them like the O words, because for a lot of people, they're very triggering, but, you know, we see them a lot, you know, even as kids, like, I remember taking those health classes and, you know, elementary, was it elementary, I can't remember. But you know, that's when you first start hearing about those things. That's when you start learning about being, quote unquote, a normal weight and being quote, unquote, overweight, you know, and that alone, it's sort of dehumanizing, right? Because you're labeling a group of people as normal. Like, think about that, like, these are normal people, and you all these other little groups, are not normal. Like, that's not okay. And it's just something that I don't think a lot of people realize because it's something that's been ingrained since we were younger, because everyone, even if you're not a health professional, you know what BMI is, because it's, you know, it's something that's taught now, but it's just that, that sort of language of being okay, so you're not normal, so we're going to categorize you as overweight.

And it's like, over what weight, like, what over? Like, why is this considered normal? And I even forgot to add that BMI, you know, to get into like, a brief history, you know, it's kind of amazing that it was like, formulated back in the 1800s, right, by a mathematician, had nothing to do with health, was not supposed to be used on an individual basis, and it was only used on white men. So that alone tells us that we maybe shouldn't be using it today, but of course we are. And also, you know, the weights were changed when a lot of the drug companies like right for the, you know, obesity, as much as I hate saying those words, like weight loss drugs, all of those things, that's when it started becoming more popular, they changed a lot of the BMI. So folks that were in the normal, quote, unquote, normal category, all of a sudden found themselves overweight, you know, so it's just like, why did this happen? And, you know, no matter what their labs are, no matter what, you know, anything is going on, all of a sudden, they're categorized as not normal, you know, that's sort of, it's just problematic, you know, so that's what, I know just went on a rampage, but it's very like stigmatizing to really be told you're not normal, when one category is normal and everything else isn’t, it’s like, come on.

Erin Judge: Yes, it perpetuates like, I mean, mental health, right, especially media. And media, whenever we grew up, I think a lot of times, we always talk about social media now, and I'm assuming we're close to the same age, we may or may not be but you know, social media, whenever I grew up, we didn't have social media.

Shana Spence: We didn't have it either. Yeah, totally.

Erin Judge: I grew up in the golden era of growing up to develop a use of internet and social media in high school, but I still grew up when women were, like, just completely torn apart, right?

Shana Spence: Ugh, those magazines.

Erin Judge: Yeah, and you look at how women were treated, and even men, I mean, just the way that we talked about people, and it was like the age of tearing apart celebrities, like the paparazzi age and it was all focused on weight. You know, it's always about, like, how thin you could be or clothes were only made for certain groups of people and only made to look one way and if it didn't work for you, like you are the problem and then social media came on. When you're thinking about this whole, like, you’re normal or not, it goes beyond just, oh, I'm either normal weight or I’m not, like there's so much mess in our brain.

Shana Spence: Oh 100%.

Erin Judge: And then if you're told, you know, by a healthcare provider to have like, oh, well, this is what you just need to do, or this is your problem. That's just going to perpetuate that and, you know, for populations like those who are dealing with chronic illness, and especially GI conditions where there's so much mystery, you already feel abnormal, then to hear something like that, that's even more damaging. So I want to talk about that part of it, of the damage that's actually done. So yes, there's some stigmatizing going on right, and that's damaging, the mental health piece is damaging. But there's also this other component of it, of health care, and quality health care, as well as, dare to say unethical health care, I guess is a good way of saying it, that comes from this focus on weight. So I'd love for you to talk a little bit about that, about beyond the human aspect, which is also there's also this system problem within our healthcare, that is not serving communities correctly, because of this focus on weight. So can you hit on that a little?

Shana Spence: Definitely. And, you know, it's not really a surprise, like, because I’m a pretty recent dietitian, so I remember being in school, I mean, I'm sure we all do, right, and we're learning these things, and we're jotting it down like it's a normal thing because you're in like a health science field, so it's not really a surprise that a lot of doctors or nurses or dietitians view it like this, because that's what we learned. So it's really kind of interesting, because it doesn't quite make sense when, like, this is how I look at it, where if you have two sets of people coming in, and they both have the same issues going on, why is one written off, as you know, just lose weight, and everything will be okay and the other one is like, oh, let's do some tests. Let's figure out what's going on, I'm gonna write you a referral to xy and z. I don't even have to say, like, which group is, you know, which, right? You know, obviously, the person in the larger body is being told, just lose weight, and everything will be fine. So I think that's a problem because I've seen it so many times on social media, even a couple of my clients who are in like, larger bodies, and they'll come back and they'll say, okay, finally got a diagnosis and it was this. And they were just like, no one was taking me seriously, I was just told to lose weight and now I have this problem that could have been fixed, if I was just given like, a normal diagnosis or referral. So that alone is, in my opinion, kind of unethical, like you said, because we're like, why is the same presentation of the same symptoms, why is one group being cared for more than the other? You know, so, that's a big problem. And, you know, I hear an argument a lot of, well, when we look at different illnesses or different diseases, what have you, we noticed that there is this like, correlation, right? Like, I'm not gonna say causation, correlation of folks in like larger bodies and so I always answer to that, I'm like, if you were constantly being told that you're not normal, that if you go to the doctor, and you're constantly just disregarded, that you're looked down upon, you're not going to go to the doctor, you're not going to go and get, you know, do that preventative care, you're not going to, you know, like, why would you want to feel stigmatized? So, folks probably aren't going to the doctor and getting preventative care. Or we're looking at other contributing factors, like, you know, access to food, access to clean water, all of these other things, you know, that we don't think about? So it's not just, yeah, well, these people, you know, that's how I hear things. That's not me. Where people are like, well, you know, like, there is a correlation and I'm just like, okay, you have to look at it a little further, you know, it takes some critical thinking. Sometimes I think we're, especially with a health field, we’re so used to things being by the book, it's very hard to look past that. It's like, okay, but you know, if you know that someone is going to look down on you, or someone's going to stigmatize you, why would you go to the doctor? Lots to unpack there!

Erin Judge: Yeah, which is common sense, like, well, yeah. But also, I love the maps where they show yes, weights might be higher in this area, we also see an increase of this condition, but also access to food is less or the poverty levels are levels or higher, or there are other things that are going on that we're not taking into account. And like you mentioned, you know, if all you're being told is to lose weight, but you're not actually being given tools to truly manage your condition, and we can use someone with diabetes for an example, if you're just being told to lose weight, some of the actions that you might take to lose weight could actually further do damage with diabetes, right.

Shana Spence: Exactly.

Erin Judge: Like skipping meals, and, you know, not eating or severe restriction, like that's actually going to worsen the diabetes. So of course, you know, those conditions might be higher from the actions that people are doing, because they haven't been given valuable tools. Which is, I mean, something within the GI world I'm really passionate about is giving tools to patients, because if they don't have the tools, like we can't expect people to improve. And so just telling someone lose weight, or just telling someone to exercise more, eat healthier, whatever it might be, it's a blanket recommendation, if they don't have actual tools, like how in the world are they meant to try to manage a condition or feel better, especially because health is going to look different for them too. And if they're trying to make you know mimic this person online, like, it's just not going to look that way and that can be really frustrating. I see it sometimes in practice, I see two sides of it. And I'd like to talk about this a little bit, because I think we focus a lot on, you know, Health at Every Size, like oh, well, it only impacts like, it only looks like this one way of you need to lose weight, right. But there's also another side of it, where, because we have such an idea, like the healthcare world, not me. But you know, we have in the healthcare world, that those in larger bodies are more at risk for conditions. Sometimes those who are in the quote, unquote, normal range, or even those who are in a smaller body, right, or have lost a lot of weight I see this often, are disregarded. Or even if there is still in a larger body, but they've lost a ton of weight because of something that's going on….

Shana Spence: They are congratulated.

Erin Judge: Yeah, right? And I see that so often with GI where I've seen the side of, you know, people talking to me and crying because their doctors refuse to talk to them because they have, you know, these extreme like gut pains and concerns and all they're told is like, oh, it's because of your weight, which when we look at like the pathophysiology of IBS, and, you know, certain conditions, like that has nothing to do, like there's nothing to do with it. There's only one that weight does maybe have an impact on but it's only one small characteristic that there are also so many other tools that can be given that just focusing on that one thing is not going to actually solve the problem. And so, you know, we don't even see that connection, but I still can see a lot of patients being told like, okay, well, you need to lose weight, we're not going to do further testing, and that makes someone feel like it's all in their head or made up.

I've also seen providers tell patients that like, oh, you've lost weight, that's a good thing. Congratulations, that's a positive. And then you look deeper and it's like, they're not eating anything, because food is causing them a lot of pain. And then they're scared of food, or now they've developed like, these really intense disordered behaviors that they're being celebrated for, just leading them down a path where their gut is not functioning like it needs to. And then I've even seen those who have lost a lot of weight or who are avoiding food and there's a lot of layers to that, but they're being told, like, oh, you know, you look fine, right? Inherently comes down to body weight, because I've pretty much never heard someone in a larger body tell me that they've been told they look fine. And I've seen those in smaller bodies who don't actually look fine, their skin is pale, and their hair is brittle. You know, it's like, there are signs that we learn in school, like what to assess. They don't look fine, but they're told that they do.

So I'd like for you to talk on that a little bit as well. Because I think there are some nuances to this. If someone's listening, they're like, oh, well, I've never been told to lose weight like this could still be impacting you and it's impacting your neighbors, your brothers, sisters like all of the beings around you. I'd love to hear your thoughts on that piece.

Shana Spence: Definitely. I think you know, Health at Every Size, it's not just meant for because that's another misconception, it's not just larger bodies. It's literally every size. So you know, I just want to make that clear too, because I get that question a lot and I forgot to touch on that. So I'm glad that we're bringing it up now, because folks who are just maybe thinner, right? And so the same rule applies, where we're not going to keep focusing on weight, we're going to focus on what's actually going on. So someone, like you said, who goes to the doctor and they're on the thinner side and they're constantly losing weight. Even still, you know, doctors are like, well, you know, that's not a bad thing, like, because we always just uphold this idea of like, the thin ideal, and, you know, even looking at, there was a study that, I don't know if in social media worlds, because, of course, I can't remember their exact name right now, but @fatdoctoruk is the handle. And they posted this study, where it shows how people who are quote unquote, in the overweight category have better health outcomes because your body is actually protecting you. So that's why it's kind of mind boggling too when folks are constantly losing weight and losing that protectiveness, you know, I'm over generalizing here, those aren't like health terms. But, you know, with the protection of your body, I think that that's something that's not looked at enough, because they're just like, well, you know, everyone, you know, can lose a few pounds, right? Like, that's how we think of it. Unless someone actually presents as sickly or, you know, has a quote, unquote, anorexic look, I think that's the only time where it's called out on and let me just say folks of any body size can have anorexia too, because it's not just your physical appearance. So I think there's just a lot of misconceptions and a lot of, you know, and I'm not saying this is every doctor, for sure, but it's just I think, for the most part, sometimes it's just easier to think about what you learned in school in that textbook, and just forget about things or just write things off.

I know how the healthcare system like working in a hospital, doing clinical I know, it's, it's a lot, right. So sometimes it's hard to really have that one on one with a patient. But you know, you really have to think about it if someone's losing weight, like rapidly, or if someone is, you know, or whatever change is happening, really think like, okay, maybe to you they look quote unquote, fine, but is that really okay? Think about it, like no one, you know, what's really going on here? So I think that just happens too much of people of any size really. It's just like, okay, well, you're still thin, so it's okay. It's like, no, it's not.

Erin Judge: Yeah, yeah, absolutely. And I think the big thing is right, changing the lens of what we're looking at people through of it and Health at Every Size is saying instead of weight and size being the main lens, it's one piece of data that we have and we might use, it's not the picture, and it's not the lens with which we should look at people through and the lens really is listening to people and actually talking to them, you know, that's a big one. And I know that's changing, I know that there are different things that are being trained and you see it in events and younger professionals, like we are seeing things change, and it's a positive, but it's not fully there yet and I think it's going to take a while. And you don't always know going in, right? You don't always know going into a doctor who's going to have what lens on and sometimes it can be hard as the person going in to know well, what am I stepping into and like are they looking at me with this lens? Are they actually evaluating more and then if you feel degraded because you're told something it's hard to also see that, wait, no, that's wrong.

If someone has experiences in the past, or maybe they haven't experienced this personally, but now their eyes are being open to oh, my health care might be influenced by this problem. What are some tools that they can use in their visits or finding a new provider, anything to move forward and get the health care that they do deserve?

Shana Spence: I think that Ragen Chastain on social media came up with a really great tool. It's the HAES worksheets where they came up with this for many different illnesses, or you know, like diabetes, whatever you think is going on or whatever you might have, there are different ways to approach it with your doctor that you can present to them without it being focused on weight. And I think it's just really smart, because unfortunately, we just have to be prepared in general, you know, especially if you kind of already know what you're going to get from your doctor, the reaction rather, it's just really a good idea to kind of have your tools, your resources, like ready to just present, I think that's such a great resource. And the ASDAH, the Association for Size diversity, they also have really great references on their website, where it's providers that are HAES, unfortunately, not a huge amount, but you know, in some ways, it might be helpful to find doctors who actually are HAES aligned, there's some out there. It might be really helpful to have those resources, but really just being prepared, I think the HAES sheets are really a great idea because oftentimes, for anybody, when you're going to see a doctor, you're like, okay, these are really smart people and, you know, it's intimidating to be like, well, you know actually, I think this. It's intimidating, because you think, you know, so I get it, and that's why I think really arming yourself with those resources, and just being prepared is just a really great idea for anyone. So those are two that I always recommend.

Erin Judge: Yeah, that's awesome. I can link those, I’ll look up those and find a link. And then I think something else is, you know, you don't have to be weighed. I think that is something a lot of people don't know, because you're funneled in right, you go to the doctor, they take you to the weight, and there are things, some situations where you do, but you don't always have to be told your weight. If you are struggling with that, you can decline. And you can also request to not see your weight or be told your weight. If they do still do that, like, it's important to stick up for yourself and say, actually I requested that you not do that. And that's something a lot of people don't understand. So if you are concerned that that will be the only focus, you can decline, that doesn't necessarily mean someone's not going to look at you and make a judgement, but if that happens, we also have to call that out, the way the healthcare changes is if we make sure to say like, hey, that's not actually correct, or, hey, that's not very kind, or you can't make that assumption about me by looking at me, you know, making sure to make those statements because we have to challenge the bias. GI, I mean, you say that with if someone, you know, makes an assumption about you, and it's not true, like, you know, I've been told like, because my dad died of lung cancer, I get told, like, oh, you must not smoke. You can't make that assumption, right. So you, like you can't make that assumption, or, you know, oh, you must already do this, or with those with IBS, you must be stressed. You can't make that assumption, like ask a question to learn more, but don't make an assumption. I think it's important. And then you know, if weight loss is recommended, you can also say, thank you for that recommendation, what other recommendations do you have? Or what are all of my other options? Like what other treatment options are there available? And if they say there's only one, then I would say, okay, show me the research where that is the only thing.

Shana Spence: Yeah, they cannot.

Erin Judge: Yeah, it doesn't exist. And I know for sure, with GI, it doesn't exist. Like I mentioned, there's only one and honestly, it's posture, it's like how tight clothes are, which has nothing to do with your size, it has to do with the clothes. There are other things right, so it's good to ask why is that a recommendation for me? What are all of my other recommendations? Or what other choices do I have, you know, what other professionals can I work with? Getting more information if someone can't answer that, then that's a good sign to find someone new.

When we're thinking about trying to change this as a whole, so those are some tools for the person who is receiving some of that, you know, can use to advocate for themselves, but putting the weight on everybody of like how we can start to change that. Do you know of resources for that or what does that actually look like?

Shana Spence: ASDAH is a really great resource because they have everything listed on there. So when it comes down to research, also resources like doctors, and so it would really be helpful for someone in case, you know, again, if you wanting to look this up, or if you feel more comfortable taking this to your doctor, it would be such a great idea to have those things like kind of ready.

Erin Judge: Yeah. Awesome. And then also supporting the conversations, right?

Shana Spence: Oh, yeah, totally.

Erin Judge: Just because you haven't experienced this bias towards you, or you don't think that you have or maybe you are in that, quote, unquote, normal range, and you believe that's better, or whatever your belief is there, don't tear down the other side without listening first, I think that's important. And I think that with all chronic illness, right, just because maybe IBS doesn't look one way for you, that is for someone else, or I've had a conversation with my friend Christine, from @myibslife, one thing we talked about is you also like, don't have a right to judge someone for doing something that might perpetuate their symptoms. That’s the same thing where like you, you have no right to judge somebody or make assumptions about somebody. Whether you believe it or not, whatever you're thinking, you know, challenge that yourself, but also be cautious and careful and responsible with your words. And that's a way that it does change, right, whenever we don't have people spewing their thoughts everywhere.

Shana Spence: And that just happens all the time.

Erin Judge: I don't know if it'll change, but I will never stop saying it because it's important, and, you know, it's like, there's a way to listen to people and not agree with them, or listen, and, you know, be open to learning without changing every belief you've ever had, you know, like, there are ways of listening. I think this is a conversation that does need that and is sometimes missed, because it seems like such a neutral conversation, right? Where it's like, oh, you know, whatever way it's like, no, this is actually bigger than that. And it's important to listen and know that you can be HAES aligned without necessarily, like completely disregarding research, like it's better to rethink things. And so just, that's a little challenge, but anything else you want to share on that? Or, you know, for those who are listening and dealing with chronic illness, and just kind of navigating all of this?

Shana Spence: Yeah, it's just hard. Like, I think that every single time I have these conversations, or I post something, I always try to imply that it's easier said than done, right? Like, everything we're saying is like, sounds a lot easier and, you know, so I get it, whenever, you know, even if you go like armed with all these things ready, you know, it's still going to be not the easiest thing to deal with a doctor who isn't non weight centric, or even, you know, asking to be weighed, I hear, like, all these stories of how sometimes, I don't know if it's on purpose or not, where people are like, okay, I’ll be weighed, but don't tell me the weight, and the nurse will still tell them and, you know, it can be very triggering. And so it's you know, a lot of these things, it's just going to take a while, but just know that it's just really a work in progress. And what we're saying is not easy, and just want to make that clear, any kind of change in the system is never going to be easy, but there are people that will believe you.

Erin Judge: Yeah, absolutely. And when you do feel down, community, right? Is that the reason why you decided to start because you're on Instagram, talking about all of these things. It's not your main work, you have a job outside of that that's kind of different. But did you create that community for that reason? What have you seen as the value of community for those who might be learning and learning also experiencing and dealing with some of those disappointments and frustrations and all of it?

Shana Spence: Yeah, definitely. Because I think it's so important, you know, and like I mentioned earlier, I had, you know, this was new to me, like, you know, when I got my dietetic license, and you know, I was still in like, the weight kind of mindset too. And it just took learning and also took, wanting to learn, I'll just put that because sometimes people won't even want to entertain this conversation. So it also takes an open mind. But, you know, it's really interesting, you know, building a community where people can feel like they can see something and either learn or feel valued, I think is really important because I am not able to get to every comment or DM, but I definitely see some of them where it's either wow, I never thought of this like that before until you mentioned it or another one is thank you for saying this because I don't see this enough. So I think it's just really important to put that out there. You know, and even in my actual nine to five job, you know, just trying to intersect the two I think is really important. But I think it's really nice to have social media again, I know it has its downsides, but that's really a place of learning, a place of seeing different aspects, different perspectives. So yeah, so that's why I continue to do you know, what I do.

Erin Judge: That's awesome. That is so important if you haven't found the provider, if you haven't been listened to, there are communities, and you're right, it's the value of social media, that there are some communities that are speaking those words and repeating them, which is also important to like, see it again and again. But then there's also people who are following and engaging that, are you, right, they're dealing with the same things, they've had the same struggles, they're also trying to, you know, fight for themselves and advocate for themselves. And there's a lot of value and strength in that of like connecting with people so that if you are disappointed, or maybe you are, you know, you have been told things that have just really left you to feed it, it's like those are the types of communities that can help because they're gonna, like stick together. So I will link Shana’s Instagram, @thenutritiontea, if you follow along with her and connect to kind of her community. Is there any other way that people can connect or anything else that you have going on through that initiative?

Shana Spence: Yeah, I mean, all my social media is @thenutritiontea, so anywhere, where any social media I think I'm on, I say that but you never know. Like, I call myself like an elder millennial, I'm always learning these things. So who knows, there might be something I'm missing, but for the most part, @thenutritiontea there.

Erin Judge: That's fair, we only do so much, so I definitely understand that. Thank you so much for your conversation, for the value that you brought to all of this. I know that people found it valuable and if you are listening, and you found this conversation valuable, or maybe you have some questions, and you're very interested and very curious, I encourage you to check out Shannon's content first, check out what's already available first, and then reach out there might be there and then reach out and ask because it's important that we all challenge these things and you know, are empowered with the tools that we need. So thank you for sharing that!

Shana Spence: Yes. Thank you!