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					What Parents and Professionals Can Do & Be
 to Participate in the Prevention of Negative
     Body Image and Disordered Eating


              Michael Levine, Ph.D., FAED
       Department of Psychology, Kenyon College,
               Gambier, OH 43022-9623

           April 25, 2008, SFU, Vancouver, BC
           [LOOKING GLASS FOUNDATION]
                  Levine@kenyon.edu:

             POWERPOINTS AVAILABLE FREE at
             http://psychology.kenyon.edu/levine/
  SCRAMBLE-FREE ZONE

     POWERPOINTS
    AVAILABLE FREE at
http://psychology.kenyon.edu
            /levine/
     After MAY 15, 2008
            Dr. Michael Levine
1. Professor of Psychology, Kenyon
   College [BMI = 30.77418 = obese]
2. Ph.D. in Experimental
   Psychology [wife has Ph.D. in
   Medieval history, teaches in
   Religious Studies and WGS – and
   watches ―Dancing with the Stars‖
   – and shops at Victoria’s Secret]
3. Age 58 [Really likes Pat Benatar]
4. No body images issues at all
Note: Rare photo--Michael Levine
      as assistant professor
                  Role Model

Grew up in Southern
California in 1950’s
  [―American Idol‖ was
  superstar:
  Mickey Mantle]


        • Alcoholic

        •Philanderer
        •Non-family
           man
  Culture and Body Image


―Somebody ought to
 do something‖
   Some Things are Like Prevention:
Hard to Understand How it Could Happen

            I could take you
            on, but I’m
            awfully busy
            with ―various
            projects‖




                               Miss America
                                  2008
       Levine’s Working Principles
              of Prevention

1.   The issue for prevention is us and our cultures, not
     ―them‖ and ―their eating disorders‖ or ―their
     obesity.‖ Thus we must think contextually and in
     terms of how each member of the community can
     contribute


2.   Prevention will fail–and may well be harmful–if it
     concentrates solely on the definition of clinical
     syndromes, the portrayal of fascinating ―cases,‖
     and the dangers of disordered eating.
       Levine’s Recommended
Principles of Truly Primary Prevention

1. The issue for prevention is us and our cultures,
  not ―them‖ and ―their eating disorders‖ or ―their
  obesity.‖ Thus we must think contextually and in
  terms of how each member of the community
  can contribute
  Preventing What? And What Does
     ―Nervosa‖ Mean, Anyway?
• Prevention will fail–and may well be harmful–if it
  concentrates solely on the definition of clinical
  syndromes, the portrayal of fascinating ―cases,‖ and
  the dangers of disordered eating.

  The issue is the cost to individuals and society of set of issues, each of
  which (1) relates to negative body image and disordered eating; and (2)
  could be seen spectrum or continuum

       negative body image           internalization of impossible ideals
       self-objectification          drive for thinness/leanness
       fear of fat                   unhealthy weight management
       shaky self-esteem +           chaotic (including binge-) eating
       compensatory                  extremes of activity/exercise
       extremes (perfectionism)
Interlocking Spectra or Helices of
        Disordered Eating
Internalization
                          Shaky Self-Esteem +
 of Impossible
                            Compensation
     Ideals




                             Giant Australian
                            Toad of Self-Doubt
              Negative      and Self-Criticism -
             Body Image       Rana Stifle-us
       Levine’s Working Principles
              of Prevention
3.   Education is a foundation, not a danger



4.   Prevention in the context of education requires an
     ecological approach



5.   Prevention in the context of education requires a
     truly collaborative approach
        Levine’s Working Principles
               of Prevention
6.   An Ecological Perspective means that we can learn a great
     deal from the prevention of cigarette smoking and other
     substance use/abuse


7.   Prevention via education means confronting and challenging
     pervasive ecological messages: Gender, Class, ―Race‖, and
     Power


8.   Culture change requires a critical/analytic perspective,
     attention to social justice, and activism--and thus it requires
     dialogue, collaboration, and courage.
         Levine’s Working Principles
                of Prevention
9.    Prevention will flourish where the teachers, students, and
      staff are engaged at different levels in the 5 C’s:
     – Consciousness-raising
     – Connections
     – Competencies
     – Change
     – choice

10. Prevention of negative body image and disordered eating
    can—and needs to-- be integrated with the prevention of
    obesity

11. Prevention requires a Bolder Model of educator engagement
    and participation: The Personal, Professional, and Political
                 Principle 11 --
 Implications of a Sociocultural Perspective: A
   Bolder Model of Prevention (Irving, 1999)


                                     "Each of us
• Personal                            must be the
                                      change we
• Professional                        want to see in
                                      the world‖
• Political
                                     - Mohandas K.   Gandhi



                    Maine (2000)
                 see www.gurze.com
                   A Bolder Model of Prevention
(Irving, 1999; Levine, Piran, & Stoddard, 1999; Levine & Smolak, 2006;
             Maine, 2000; Piran, 2001; Sigall & Pabst, 2005)

                                                 5 Components of
Cultural Literacy
                                                Effective Prevention

Awareness                  Personal                Collaboration

Analysis                Professional           Consciousness-Raising

Activism and             Political                 Competencies
Advocacy                                       Choices and Changes
                     ―You must be the change
Access (e.g., to                               [adapted from gender literacy
media)                   You wish to see          work of Sigall & Pabst]

                          in the world‖
                             - Ghandi
                        The Personal
Body Image: Remember and Practice The Bill of
 Rights: ―I have and will exercise the right to‖
 •   Nourish my body and spirit
                                    •   Remind myself,
                                        constantly if necessary,
 •   Appreciate my body, which          of the following 10 or
     will never be perfect              more good things about
                                        my body
 •   Feel good in and about my
     body
                                    •   Be fit and energetic, no
 •   Remind myself that there           matter what I look like
     are hundreds of very
     admirable people whose         •   To dance, swim,
     body shapes vary                   sunbathe, and be active
     tremendously – my role or          no matter what I look like
     real models
                                    •   To wear clothes that are
 •   Exercise my control over           comfortable and express
     what I watch, pay attention        my self—my style—no
     to, talk back to, buy. . . .       matter what I look like
Which one of the these women is
          a ―Model‖?
   Nobel Prize
       for
   Literature,
      1993




                     Xena, Warrior
                       Princess
                      Doll/Action    Spain - 2007
 Ms. Chloe Anthony     ―Figure‖
      Wofford
      “Role Model” (www.m-w.com)
A person whose behavior in a particular role is
  imitated by others
                The Personal:
     Basic or Model Questions
• Do you have at least one role model?
• List 3 characteristics that make that person a
  role model for you?
• Do you own or have access to a picture or
  image of that person?
• Do you have that picture or image prominently
  featured in your classroom and/or office?
• Have you ever talked with a close friend or
  lover about that role model -- who is it? Why he
  she is a role model for you? What that person
  means in your life?
             The Personal
      Who are Your “Role Models” –
           and Why Exactly?
• Consciousness-
  Raising
• Connections
• Competence-      Kids-on-the-Block-VT
  Building
• Change
• Choices and
  Control

                           Eating Disorders Coalition
         Multifaceted Health Promotion
Negative body image, disordered eating, and obesity –
On shared ground: HAES Philosophy (Robison, 2003)
                •   Self and diversity
                    acceptance, supported
                    supported by people who
                    care about you as a whole
                    person
                •   Enjoying physical activity
                    and a more active lifestyle
                    in accord-ance with needs
                    and rights
                •   Making more peaceful,
                    social, and celebratory
                    relationships with
                    nutritious, nourishing food
                •   Living better through
                    critical consciousness and
                    everyday acts of rebellion
                The Personal:
 Love – Or at Least Accept and Care For – the
               Body You’re With
• Body dissatisfaction is neither
  ―feminine‖ nor ―normal‖
  in the sense of being natural
  and unchangeable
• Body dissatisfaction is not
  motivational
• Body dissatisfaction is typically
  not harmless
• Body dissatisfaction often
  feeds on prejudice, trauma, and
  objectification
The Personal and Body Image: Be a Real
            ―Super‖ Model
 •   Reject weightism as an untenable form
     of prejudice

 •   Modify your body image, not your
     weight and shape
     a.  Practice refusing self-criticism,
         not restricting
     b.  Draining the mirror & scale
     c.  Drunk on the street test

 •   Make contact with people,
     not war on your body, your mind,
     your spirit. Refuse ―fat talk or the BDG

 •   Hill’s ―Daily Diet of Praise‖ – Affirming
     skill, strength, care, ―presence‖
                  THE PERSONAL
   Body Image: Be a Real ―Super‖ Model

Study culture, cultures,
history, gender, resistance,
transformation--for both
boys and girls

Talk to others, making
the private into the public

Promote safety, respect,
and substance
  The Personal: Sensible Nutrition, Activity, and
           Other Changes for Health

[Make healthy lifestyle changes, not war
  on your weight, your body, and your
  spirit]
• Nourish yourself with sufficient fuel –
  eating small(er) amounts throughout the
  day
• Don’t diet -- reject the dieting mentality
• Eat less salt, red meat, saturated fat
• Eat more fruit and vegetables
• Exercise and Be Active for the four F’s –
  Fun, Fitness, Friendship, and Function
                     THE PERSONAL:
              Sensible Nutrition, Activity, and
                Other Changes for Health

[Make healthy lifestyle changes, not
war on your weight, your body, and
your spirit]

• Make meals sociable and pleasant

• No calorie- or fat-talk at meals

• No watching people eat

• Turn off the ―gosh-darn” TV

• What‘s eating me? Not ―What
  am I eating?‖
 The Ecological Perspective Reminds Us:
          Prevention is Primary

Cowen (1973, 1983) -- broad but distinct concept:

1. targets a group, not individuals

2. targets those who are well, although they may be at risk
   by virtue of life circumstances

3. has a more impersonal focus on changing groups, institutions, and
   communities

4. ―intentional‖ intervention that applies knowledge to strengthening
   psychological health and forestalling maladjustment.
                        The Professional:
      Implications of Current Research on Prevention in the
                        Schools (at least):
                    An Ecological Perspective

    Of or pertaining to the totality or
    pattern of relations between
    organisms and their environment

•   Sociocultural factors
•   A spectrum of problems
•   Limits of classroom programs
•   Lessons from other areas of
    prevention
•   Definitions and models of prevention


                             ―Open Season‖
       Implications of Current Research:
An Ecological Perspective Means That Prevention
 Should Involve Boys and Men in Various Ways
        The Professional:
The Ecological Perspective: Health
       Promoting Schools
                    • School ethos
                    • School
                      curriculum
                    • School-
                      community
                      partnerships
     Health Promoting Schools – Ethos:
           Staff as Role ―Models‖
• Dressing with style and individual expression regardless of
  shape and weight
• Refusing to avoid activities because of body image issues
• Enjoying a variety of foods in front of students
• No ―fat talk‖
• Exercising for the 4 F‘s: Fun, fitness, friendship, function
• Practice ―talking back‖ to culture
                School Ethos -
               Action Committee

• Resource, action, and advocacy group
• Dialogue and needs assessment
• Action committees, with administrative
  support and academic connections
• School’s missions
  –   Literacy
  –   Citizenship and Leadership
  –   Service
  –   Community engagement
             School Ethos -
      Action Committee (continued)
• Policies and Training
  – e.g., teasing and harassment

• Ecological review
  – posters, contests, practices
  – multiple opportunities for success in ways that de-
    emphasize appearance for young women and
    ―predatory mooking‖ for young men
  – emphasis on various forms of helping, including
    reaching out to peers, community service

• Food Service
• Educational needs of professors, graduate
  students, libraries, coaches
            School Ethos -
  Action Committee – A HIER Approach
• Policies and support

• Community preparation
  and collaboration

• Purposes

• Do’s and Don’ts
     Curriculum: A Disease-Specific
       Social Cognitive Approach
REDUCE =>                       INCREASE =>
•   Slender ideal
•   Negative body image         • Healthy eating and exercising
•   Prejudice against fat and   • Healthy weight management
    fat people
•   Centrality of weight and    • Critical thinking & other
    shape                         resistance skills
•   Good vs. Bad foods
                                • Self-acceptance
•   Calorie-restrictive
    dieting                     • Skepticism about dieting
•   Low self-esteem
                                • Concern with eating disorders
Social Cognitive Approaches: Key
            Features
 • Source of Change: Teacher or Mental health
   professional

 • Pre-determined Lessons with at least some, if not a
   large amount of information

 • Individual and group activities, e.g., videos,
   discussion, worksheets, role-playing

 • Sometimes individual cognitive-behavioral work

 • Sometimes integrated with information for parents
   or teacher workshops
Best Practices in Elementary & Early
Middle School: Kathy Kater’s Program
   10 Lessons for grades 4 through 6
   Cannot and should not try to control
        developmental changes of puberty
        impact of genetics on size and shape
        short- and long-term impact of calorie-restrictive
         dieting
   Can and should try to control
        multifaceted identity vs. appearance-focus
        moderation and variety in nutrition and exercising
        selection of realistic, resilient role models
   Thinking and knowing
        media literacy
        history of attitudes about bodies and body image
        Non-Specific Vulnerability-
       Stressor Model (Albee, 1987)
• Increasing coping and other life skills, for example:
  decision-making, communication, coping with stressors,
  assertion

• Increasing self-esteem and positive self-image, especially
  in terms of multiple interests and competencies

• Increasing social support (e.g., during transitions)

• Reducing stressors (e.g., teasing, harassment, prejudice)

• Changing environments and institutions to promote
  support for respect, health, competence, etc.
              NSVS Approach:
    Key Features (O’Dea & Abraham, 2000)

• Teacher facilitated, discovery-based & cooperative
  learning
• No mention of weight, eating, nutrition, dieting
• Integrated into ongoing health curriculum
• Multiple, engaging activities for life skills, social, and
  self-esteem
• Emphasis on bringing parents, peers, and other adults
  (e.g., grandparents) into the process
• Communication skills for support and for appreciating
  and respecting appearance of self and other
    Empowerment-Relational Model
         (Piran, 1999, 2001)
• Emphasis on gender and the experience of being
  in, or disconnected from, one’s body
• Based on girls’ and women’s experiences in
  specific contexts, not didactic lessons
• Empowerment within dialogue within
  relationships
• Girls and women as authorities, not the experts
• Body as a site of power and transformation, not
  private shame
• Transforming the personal into the political:
  Activism and systemic change
Critical Social Perspectives Programs:
    Successes & Partial Successes
 • Piran (1999): Canada (Elite Ballet School)
       • reduction in incidence of eating disorders

 • Neumark-Sztainer et al. (2000): USA Girl Scouts
       • reduced internalization of slender beauty ideal
       • increased self-efficacy for activism in regard to weight-
         related norms
       • no sustained effect on dieting or body-size acceptance

 • Steiner-Adair et al. (2002): Full of Ourselves - USA
   middle school girls
       • sustained improvements in body satisfaction
       • no sustained effect on internalization of beauty ideal
       • no effects on weight management such as dieting
           The Professional:
  Conclusions About Universal-Selective
      Prevention in the Classroom
• Good outcome research remains limited

• There is an encouraging theoretical and research
  basis for prevention – it simply is not true that
      [a] ―prevention changes only knowledge,‖ and
      [b] ―no studies have shown a long-term effect‖

• Value of psychoeducation as a foundation. . . .

• However, with a few exceptions, programs to date
  have either not really assessed prevention or have
  had limited long-term effects
           The Professional:
Conclusions About Prevention (continued)

• The program participation effect indicates
  that a more intensive, participatory,
  ecological perspective is needed

• The issue is ethics, not iatrogenesis = failure;
  be concerned about, but preoccupied with harm

• No systematic work on selective-targeted
  prevention with elementary and middle school
  children
              Principle 3:
Education is a Foundation, not a Danger

      Content              Processes
 • The Clash             • Dialogue
 • Critical analysis
 • Gender and identity   • Discovery
 • Health and            • Teaching
   performance  well-
   being                 • Social norms
 • Action and activism
 • Media and cultural    • Integration
   literacy
             The Clash
 as a Focus in Preventive Education
• Biodiversity vs. Cultural Straitjackets

• Biology of weight, shape, and hunger
  vs. the Hydra of Cultural Nervosa

• Weightism as Domestic Violence vs.
  Knowledge and Voice about what’s Fair
  and Decent
              Implications of Current Research:
An Ecological Perspective means that we can learn a great deal
from the prevention of cigarette smoking and other substance
                          use/abuse

                   •   Engaging students
                   •   Normative expectations
                   •   Critical thinking
                   •   Life Skills
                   •   Peer involvement
                   •   School policies +
                       classroom work
                   •   Community
                       programming
  Goldberg et al. (2000) – The Adolescents Training &
    Learning to Avoid Steroids (ATLAS) Program

Education, media literacy, media
  advocacy, refusal skills, nutrition &
  strength training
HS football players (vs. controls) – 1
    year FU
-- greater knowledge (exercise, AS)
-- less investment in images of use
-- less intent to use
-- less new use
-- saw coaches as less tolerant
ATHENA for girls
http://www.ohsu.edu/hpsm/atlas.html
    School Curricula – ―Planet Health‖ and
              Topic Integration
• Nutrition and the bio-psycho-social-cultural dimensions of
  eating for health and well-being
• Prejudice, fairness, and respect
• Genetics and diversity
• Psycho-biology of weight and shape regulation
• Weight and shape changes during puberty
• Stress (including transitional stress) & coping
• Nature and dangers of calorie-restrictive dieting and of obesity
    – What do we know? How do we know it? What don’t we know?
•   Anthropology & economics of food production & consumption
•   Media literacy, including the business of advertising
•   History of fashion, critique, and courage for males and females
•   Sports – sociology, science, media, marketing, etc.
•   Philosophy of mind-body relationships
Implications of a Sociocultural Perspective:
       Critical Reflection & Life-Long
                   Literacy
  ―A democratic
  civilization will
  save itself only if it
  makes the
  language of the
  image into a
  stimulus for critical
  reflection--not an
  invitation for
  hypnosis‖                Quotation appropriated from
                           Media Education Foundation
                                    Quotation appropriated from
       -- Umberto Eco              Media Education Foundation
      Media Literacy and the 5 A’s: The Cycle --
         from GO GIRLS!TM [www.nationaleatingdisorders.org]

                  …Embedded in a Sociocultural Context...

                   Critical Awareness & Analysis
                      in a Relational Context
                  Consciousness-raising through Connection
                               Competencies
                            Choices for Change

                                   Actions
                              May involve gaining
                             ―Access‖ to mass media


            Activism                                  Advocacy & Access
Including actions taken TOWARD media          Including actions taken USING media
                   A Bolder Model of Prevention
(Irving, 1999; Levine, Piran, & Stoddard, 1999; Levine & Smolak, 2006;
             Maine, 2000; Piran, 2001; Sigall & Pabst, 2005)

                                                 5 Components of
Cultural Literacy
                                                Effective Prevention

Awareness                  Personal                Collaboration

Analysis                Professional           Consciousness-Raising

Activism and             Political                 Competencies
Advocacy                                       Choices and Changes
                     ―You must be the change
Access (e.g., to                               [adapted from gender literacy
media)                   You wish to see          work of Sigall & Pabst]

                          in the world‖
                             - Ghandi
          Aggression in
       Service of the Ethnos

                   ―Somebody
                      ought to
                  do something‖




Kappa Slappa Ho      ―The Ultimate Driving Machine‖ [as]
                        -- ―The Ultimate Attraction‖ --
  “We’re Not Going to Take It”
                                      ―When will women not
                                        be compelled to view
                                        their bodies as
                                        science projects,
                                        gardens to be
                                        weeded, dogs to be
                                        trained‖?
                                        Marge Piercy, cited in M.
                                        Maine (2000)
1983 Nobel Prize Winner (Chemistry)
       Barbara McClintock
                                      • ANAD & Hershey’s (1988)
          at Cornell, 1929            • EDAP & Hormel’s (1996)
A Small Group of Citizens -- NEDA and
  Eating Disorders Awareness Week

 • First EDAW – Mt.
   Vernon/Knox
   County – Fall
   1983
 • First National
   EDAW – 1987
 • 20th Anniversary
                        Feb. 14, 2007
But What, “Like, Really,” Can Anybody Do?

 Kenyon
 2001-2002 
 Andy Mills & Becky
 Osborn & Erica
 Neitz (’01)
   (with support from Drs.
   Levine, Smolak, & Murnen

   and

   several counselors, teachers, and
   principals in the Mt. Vernon City
   School System)                      See www.gurze.com
         THE POLITICAL:
       Hope is Everywhere
[and so is determination and skill]

• Dads and Daughters, Inc. –
  Joe Kelly and Nancy Gruver




• www.dadsanddaughters.org
• Protest, praise, advocacy
 One Person in a Small Town Can Begin the
      Process of Making a Difference
A great model – an ongoing narrative of courage, resistance,
and change – is the Red Wing, MN non-profit organization
described at Higherself.com, which grew out of the GO
GIRLSTM program guided by
Sarah Stinson


 High school girls who have
 •Protested
 •Taught
 •Advocated
 •Testified in the US congress
 •Formed a non-profit corporation
          It’s Time, No?
      Time to Get it Together
 ―At the age of six
 I wanted to be a
 cook. At seven I
 wanted to be
 Napoleon. And
 my ambition has
 been growing
 steadily ever
 since.‖
— Salvador Dali       Soft Watch at the Moment of First
                              Explosion, 1954
        Collaboration is Key: OR
―How Many Levines Does It Take to Change A
               Culture?‖




  Michael –      Paula -     Richard –
Gambier, Ohio   Miami, FL   Hershey, PA
  IT‘S TIME TO STAND UP IF –
YOU REALLY DO BELIEVE THAT

The type of person you are
• your character,
• your substance,
• your spirit and guts
are more important than your
weight or pants size.
IT‘S TIME TO STAND UP IF -- YOU
  REALLY DON‘T BELIEVE THAT

Every person
is entitled to
respect and dignity

no matter what their
size and shape,
their apparent fitness,
the color of their skin,
or their gender
It’s Time to Stand Up and Take on and Take Up Space –
                   The Final Frontier

                    Work to surround yourself
                    with, and connect yourself
                    and your loved ones to,
                    women of substance;
                    women who take up space
                    in the world and have
                    something to say about it
    Queen Latifah
                                                 Carolyn Costin




                      Margo Maine
 Wm. Elliot &
       Amy Dennis                                 Linda Smolak
   IT‘S TIME TO STAND UP IF –
 YOU REALLY DO BELIEVE THAT

People -- and especially girls --
should treat their bodies as objects,
things, and commodities to be
sculpted, starved, leered at, jeered at,
sneered at, and painted into shape --
that people’s bodies are in many
ways no different than cars. . . .
 IT‘S TIME TO STAND UP IF -- YOU
   REALLY DON‘T BELIEVE THAT

You can tell how good a person is -- how
talented, caring, friendly, trustworthy,
funny, spirited, spiritual --

by watching what they eat and seeing
how much they weigh or whether they
―work out a lot and look ‗hot‘ but
somehow ‗cool‘
IT‘S TIME TO STAND UP IF -- YOU
   REALLY DO BELIEVE THAT

People should work together with their
family, their friends, their colleagues, their
church, and other groups who refuse to
keep silent and to sit still when they see
injustice and lack of necessary resources
in the world –

That it is important to take a stand for what
is HEALTY and RIGHT and DECENT. . . .
  IT‘S TIME TO STAND UP IF -- YOU
       REALLY BELIEVE THAT

  Individual differences --
  diversity -- in height and
  weight and body shape are a
  very bad thing, and
• that all girls should be tall
  and thin
• while all boys should be tall
  and muscular, and
• people should be more like
  the manikins in the store
                                     Model for Rosa Cha
                                  Spring 2007 Fashion Week
Hope is the Thing with Feathers . . . .

―Never doubt that
a small group of
thoughtful
committed citizens
can change the
world. Indeed, it’s
the only thing that
ever has.‖
-- Margaret Mead
                   Pillars of Fulfillment – Tribute to Dr. Lori
                         Irving by ―Women Who Weld‖
                   Washington State University, Vancouver, WA
And the Wisdom to Know the Difference

				
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