Shireen: In today’s episode, we are joined by Dr. Maggie Smith to delve into how family history and upbringing shape an individual’s weight beliefs and management practices. We uncover examples of how family members’ experiences with weight, both positive and negative, can significantly impact how we view our own bodies. Additionally, we discuss the influence of cultural and generational differences on weight beliefs within couples and families exploring how these differences play out in our lives. Stay tuned.

Dr. Maggie Smith is a marriage and family therapist and behavioral health faculty member in the Department of Family and Community Medicine at UT Southwestern. She’s involved in integrated behavior, health, patient care, resident education and research. A lot of her research focuses on the role of couples and families in our body image, weight beliefs, and disease management, as well as ways to combat weight discrimination and stigma within primary care and family systems. Welcome, Dr. Smith.

Dr. Smith: Thank you so much. I am so excited to be here. 

Shireen: An absolute pleasure to have you on. In fact, this, this topic itself, I feel like this 20 minute episode is not going to cut it. I feel like we’ll need, we’ll need to do an, they’re already just going and given your background. What an incredible background itself. Dr. Smith, let’s start out with just learning a little bit about you. What inspired you to explore the influence of couples and families on weight beliefs? 

Dr. Smith: Yeah. So my entire life going into college, I never really had to think much about my weight or my body image mostly because I’ve had been privilege my entire life and that was never something that anyone told me that I had to, to think about. When I got into college, I started becoming more conscious about my health. And so it started from this place of good intentions to be healthier and to pursue different, different avenues to do that.

But it is a very thin line in, in the health and wellness world between healthy behavior and disordered behavior. And so I slowly started to cross that line into disordered eating and just a lot of really negative body image thoughts that was extremely consuming and it was, it was a slow fade. And sometimes you don’t realize what’s happening until you’re till you’re deep into it. When you notice that all you’re thinking about is food or your body or how your body is being perceived. 

And I’m really grateful that I did realize what was happening. So I was able to get some support before it got worse. And I was able to do a lot of work to heal my relationship with health and my body and food. And it’s something that really inspired my passion for helping others do the same.

And also maybe more aware about how people in different bodies than, than me in larger bodies experience the world and how there is a lot of stigma and discrimination that that occurs for those people and how that’s a social justice issue. And also ignited my passion to, to create more equity and to decrease weight stigma in the effort to help people heal their relationships to, to their bodies and food. 

As a marriage and family therapist, that’s my training, I’ve got my master’s and PD and marriage and family therapy. And so I also am very passionate about how our relationships impact the things that, that I’m passionate about. So, thinking about how do our partner relationships, how do our family relationships impact our body image and our relationship to food?

And how can can those different relationships be be a positive influence rather than a negative one? How can we help families and partners transform the way that, that they approach food and we talk and bodies within their own relationships in order to create healthier family systems around body image and food, food, talk.

Shireen: Lovely. And and with that, help us first, just get some baseline information around this. Can you explain exactly how family members’ experiences with weight, whether positive or negative, can really shape an individual’s perception of their own body? What is, what is that relationship?

Dr. Smith: Sure. So what we know and this is something that probably we’ve all experienced is that our family messages matter a lot. So the messages that we get from our family, the beliefs we get from our family really shape how we view ourselves and also how we, how we view the world. This kind of comes from a theory called attachment theory. And basically, it just says that we perceive safety and also either develop either positive or negative beliefs about yourself or the world based on the perceived safety of our caregivers or our of our partner and adult relationships. 

So if we receive negative messages about our bodies or weight from the people who are supposed to be that source of acceptance and belonging, then we can internalize this as rejection, which can shape a negative view of ourselves and our bodies on the flip side though, if we receive positive messages about bodies, regardless of size and find our families to be a safe haven or a place of protection from the more negative messages of society involving weight and body image, then we start to internalize this as belonging and acceptance and we develop resilience against those messages and that can shape a more positive view of ourselves and our body image. 

Weight talk can occur in multiple different ways in families. I think sometimes we think weight talk is only the teasing or the direct commentary about weight and that’s definitely one type of white talk but also can occur in more sneaky ways. So just encouraging to diet or encouragement to to restrict food, making suggestions about how, how to do that. We commentary about your own body. So if you’re a parent and you’re making negative comments about your body, your child can hear that and internalize that as well as a message about about bodies and body size.

Also, if, if we’re making comments about other people’s bodies, even if it’s not a family member or a child or our partner, our family members still hear those comments and that can help shape some of those negative views of, of their own bodies. Most of the research that we have focuses on that parent child relationship, but I think it would be a solid hypothesis that these same findings could apply regardless of the type of family relationship.

So we know that any sort of weight commentary, so that family weight teasing, encouragement to diet, talking about your own body negatively or other people’s bodies negatively, leads to unhealthy weight control behaviors, negative body image, a sort of eating, depression, binge, eating less physical activity, higher BMI so all sorts of more negative health outcomes can can occur due to this type of weight talk. 

But on the flip side, if partners focus more on, on health in those conversations, so health talk instead of weight talk, and focus more on health outcomes and help their family develop pride and respect for their bodies, this leads to more positive outcomes. So less disordered eating, greater, greater self esteem, greater body appreciation. And in fact, when parents have a more positive relationship to their own body, this increases the self-esteem and body appreciation in their kids just kind of a systemic trickle down effect.

So as you can see families can have either negative or positive effect depending on how weight and health and bodies are talked about within the family, 

Shireen: You know, double clicking in into that a little bit, how do the health behaviors of one partners in a couple often impact the other partner’s own approach to maintaining a healthy weight? We hear that a lot. But what, what can you point us to some of the research around this?

Dr. Smith: Yeah, that’s a great question. So this area of research is still being explored. So we don’t actually know as much about the role of partner relationships and and those outcomes as much as we do about parents on, on their kids or teenagers outcomes. But what we do know in the research that we have is that it’s very similar to family influence.

So weight, commentary or negative food or body talk has shown not to be very helpful in maintaining positive health outcomes. So that encouragement to diet or criticizing weight or even providing just feedback on, on someone’s weight contributes to negative outcomes for both the individual and the relationship. So similar patterns that can lead to disordered eating, binge eating body dissatisfaction, but it also can lead to less intimacy and greater conflict in the relationship. 

Also, higher weight talk within relationships has been shown to lower the likelihood that a partner is going to be engaged in health behaviors. So if a partner is making comments about their partner’s weight or engaging in any sort of weight talk, the other partner is actually less likely to, to engage themselves in health behaviors.

But similar as families on the flip side, when you have more positive, secure supportive, partner relationships, that increases health behaviors. For the other partner, it increases mental health, increases physical activity, vegetable and fruit intake. And we also have seen that equalizing power dynamics and increasing autonomy for each partner can increase these health outcomes for, for partners as well.

So basically, what we know so far from the research is that practicing health behaviors together and also modeling health behaviors is way more effective and promoting health than the making comments about weight or centering the conversation about weight. And also that’s that just practicing these health behaviors together is even more effective at times than weight loss itself.

So if we focus more on health and health behaviors rather than weight loss or weight, that can sometimes be more effective in helping people engage in some of these behaviors and helping your partner engage in these behaviors as well.

Shireen: How interesting, you know, you mentioned a little bit about up upbringing and the the impact that family can have. You know, speaking of upbringing, how do childhood experiences and conversations about weight influence an individual’s approach to health behaviors later in life?

Dr. Smith: Yeah. So that is a great question. So we know that any weight commentary, weight talk from family members in childhood and adolescence impacts health behaviors up to 15 years later. That’s the research that we have. We see that family weight teasing, encouraging teens to diet or restrict food, labeling a teen as overweight or too fat, whether that be from a primary care provider or a parent, leads to more negative health outcomes.

So we see higher BM I, higher unhealthy weight control behaviors, higher depression, lower self esteem. And again, similar, it’s not only just direct, weight talk about the, the child or the teenager’s body, it’s also speaking negatively about one’s own body to, to influence those outcomes. So we see similar, similar disorder eating, similar unhealthy weight control behaviors, depression, when kids hear their parents talk negatively about their bodies and they internalize those messages. 

We also know though that more intuitive or weight neutral approaches lead to more positive outcomes. So experiences of intuitive eating. So making food decisions by tuning into your body and paying attention to cues and cravings rather than tuning those out. And following just external food rules that this predicts more positive health outcomes long term into young adulthood.

So we see lower depression symptoms, more positive body image, higher self esteem, less unhealthy weight control behaviors, less binge eating. And we also see higher vegetable intake and overall diet quality later in life. And so it can be helpful when raising our kids and raising our teens to practice more intuitive eating in our own families.

So avoiding moralizing food or labeling it as good or bad. Discussing how different food can help us reach different goals, so if you need energy for a long time, maybe this might be a good food choice. If you’re seeking connection or comfort or joy, maybe then this is a good food choice. So encouraging our kids to make decisions about food based on how our bodies, makes their bodies feel rather than how it makes their bodies look. 

We also know that regular family meals together leads to positive health outcomes long term. So when we focus on having those regular family meals, and regardless of of what, what we’re eating, that can lead to our positive outcomes long term. So those are a little ways in a few ways in general that those experiences can impact us later in life.

I know that there’s also some difference, cultural differences and in that as well. So I can speak to that a little bit too if that would be helpful. But research kind of shows mixed evidence in terms of how different cultures, how that impacts our body image and disordered eating behaviors. 

Some research shows that certain racial and ethnic cultures that promote thinness or muscularity more than others that, that puts people more at risk for developing body image issues and disordered eating later in life. While other racial and ethnic groups that don’t promote the thinner muscular ideal can help protect against some of those, some of those negative outcomes. Other research shows that that doesn’t quite matter because of the world that we live in, that we’re all exposed to this American thin ideal, muscular, ideal, hourglass ideal. And so that kind of places everyone at risk for disordered eating and body image struggles. 

But what we do know in terms of health and health behaviors is that stigma, or stigma induced stress, and equity in health care access is a major influence on health behaviors in BMI. And sometimes a lot of research has shown that the stigma, so chronic stigma, chronic discrimination impacts health more than BMI itself.

So while there are disparities in health outcomes across cultural identities, a lot of the research points that this is more likely influenced by systemic stigma and discrimination more so than individual behavior or failure. We know that stigma and related stress is related to higher BMI, higher risk for cardiovascular disease, higher risk for hypertension and diabetes.

And so it’s not always effective to encourage people to lose weight, to improve these health outcomes if we’re not first addressing some of these systemic stigmas and injustices that are happening. And so if we can focus more on increasing health behaviors and also advocating for some of these barriers to be removed, that can be a more culturally inclusive approach. So we’re not putting the individual blame on, of a systemic problem on our individual family members or patients. So we’re kind of addressing it from both the individual place and the systemic place, if that makes sense. 

Shireen: It does. And you know, and again, just going into it a little bit more, can you help point to perhaps specific phrases, behaviors, attitudes from parents, family members, spouse that can have that long lasting impact? You know, you mentioned a minute ago just having that impact of up to 15 years just from, you know, language that may be used in childhood. Can you point to certain phrases and then also help us distinguish to say something like instead of saying this, this is how you should perhaps phrase a concern coming again from that health lens. Can you walk us through a couple of those?

Dr. Smith: Yeah, 100%. It’s kind of speaking to the intuitive eating piece that I just talked about. It’s really important that we emphasize the message that all food can fit. That food is not good or bad. Food is morally neutral. A lot of times if we emphasize that food is good or bad or bodies are good or bad if they’re thinner or, or they’re not as good if they’re larger, then kids and teenagers start to internalize that they are good or bad if they make certain food choices or if their body looks a certain way. 

And so if we can start to separate worth and value from food choices and body size, that’s really important. So again, helping our kids and teens tune in to their bodies. So what types of food makes them feel full for longer periods of time? What types of food maybe makes them feel full temporarily? But then they’re hungry two hours later, how do we decide then what to eat? Maybe we need some more protein or maybe we need some more fiber if we’re trying to stay full for longer. 

Also helping them to realize. Ok. Well, after we ate a certain amount of food or a certain type of food, how does it make our body feel? Does our body feel good or does our body hurt in certain ways? And how can that help us make decisions? So asking kids and teenagers to check in with themselves when they’re eating, to check in with themselves before they’re eating of, are they hungry? What are they hungry for? Checking in while they’re eating, Am I still hungry? Am I full? And then also checking in after of how did that food make me feel? 

I think it’s important that we avoid any moralizing language such as, oh, I’m so bad today. I ate the cake and instead saying I, I was having fun at this birthday party and I got to eat some cake making sure that we’re not moralizing cake as bad and that we are not bad for choosing to eat the cake.

Also on the flip side, avoiding moralizing being good. So saying, oh I was so good today. I didn’t have any sugar or today was my cheat day. We see all this moral language around food and that can be really harmful when it comes to developing intuitive relationships to food. We actually kids have a pretty intuitive relationship. And so it’s important that we help them maintain that connection to their bodies rather than detach them and turn them against their bodies. 

Similar with, with body size. How can we avoid making comments that thinner is better or healthier and fatter or larger bodies are worse or not as healthy health and weight are not the same thing. And that’s a common misconception that we’re all taught. But there’s actually a lot of differences between the two and people at higher weights are not necessarily less healthy than people at lower weights. There’s a lot of reasons that people have the different bodies that they do, and everyone can practice health behaviors no matter their body size. So emphasizing that message that all bodies are good and all bodies have the capability to practice health is really helpful.

Shireen: How can couples and families really create a positive and empowering atmosphere that promotes healthy weight management without again breeding that negativity and shame. What can they do?

Dr. Smith: So like I just said, kind of emphasizing that message that weight does not equal health. So there’s a lot of other contributors to health that we actually have way more control over than our BMI or our weight. So we’re thinking sleep or blood sugar or inflammation. So how can we maybe shift our focus away from weight and more towards these health outcomes and improving these health outcomes through, through behaviors. 

And thinking about how we can, like I said, increase health behaviors and that doesn’t mean just simply decreasing weight. There’s a lot of ways to do that. Even if we aren’t effective in decreasing weight, we can still improve our health and using freedom based intuitive based language rather than shame or fear based language like I just mentioned and that a lot is using weight, weight, neutral language. So health based language rather than, than than body size or weight based language. 

Avoid teasing or making comments about people’s body size or weight. And we know that that is extremely effective in improving outcomes, modeling, our own intuitive and shame free behavior around food and weight, which is tricky because we all have our own baggage around food and body image and weight. And so one thing that we can do to decrease the shame and activity in our own families is to do our own work around some of those things that we believe about our own bodies and about food. And that sometimes is the hardest part is to do our own work so that we can model that for the rest of our family. 

It’s also helpful to do things together. So doing physical activity as a group activity, that’s something that people can choose to join if they want, but they’re not forced or shamed to join. And again, we’re modeling without maybe directly forcing someone to do something that would increase shame or increase fear because we know that’s not super sustainable in making any permanent change if it’s based in shame or fear. 

And again, focusing on how food and movement make us feel rather than how it makes us look. I think that that is a really important way to develop a shame free health based approach is how does this make us feel rather than how am I gonna look? Because I’ve done XYZ or how am I gonna, how much am I gonna weigh if I do XY or Z?

Shireen: I love that, that change in approach, focus on the feeling rather than how you look or how, how one looks, you know, and then speaking of how one looks, how are your societal standards, you mentioned a minute ago, this sort of this American model of thinness and skinniness, how do these societal standards of beauty, body image really impact again, couples, families and their collective health belief?

Dr. Smith: Yeah. So I think it’s no surprise to any of us that it impacts that a lot. So these messages that we’re all exposed to about body image and about food and bodies and the the different value across different bodies, it definitely impacts our own relationship to our body image and to food and to weight. We all live in a society if we live in this country that has a really complicated narrative about weight and its relationship to health and value and worth.

Our society tends to glorify thinness and demonize fatness, which kind of sends this message that thin bodies, or thin people, are more valuable or more healthy or more worthy of space than, than larger bodies. And that is something that we’ve all been exposed to for years and years and years. And so it’s not our fault that we’ve internalized some of that, that weight bias or those, those beliefs about fitness and fatness and health. 

And that can, that’s what kind of leads to some of those weight talk in families. It’s oftentimes coming from a really well intentioned place of wanting to protect their child or their partner or their family member from harm or pain. A lot of people have their own really negative experiences about being teased about their own weight or they’ve experienced weight discrimination in other ways and they really want to protect their family members from that.

And they might also want to be protecting their family members from negative health outcomes. They’ve been taught or do to, to weight. Like I said, in reality, that relationship is a little more complicated. But again, it’s coming from this really good place. Sometimes they’ve never experienced anyone talking about their bodies or weights. They don’t understand the pain that can come from that. 

And so all of this can contribute to this weight talk that comes from a good place, but the impact can be harmful. And so just like any other internalized bias that we have around race, around gender, around sexual orientation, we almost do our own work to undo what we’ve learned about thinness, fatness and health and check our own bias and our own stigmatizing beliefs to help promote more positive relationships about body image, food and health within our families. 

So part of that is learning, teaching, practicing media literacy, calling out comments that glorify thinness or demonize fatness on TV, or in books. Creating conversations around how characters are depicted. So if we’re noticing larger body characters are being depicted as, as one way, whereas thinner, thinner characters are being depicted in another way, how can we create that conversation within our families to combat some of those messages about thinness and fatness? 

So basically starting to challenge some of the systemic weight stigma and stereotypes that we, we all experience and it starts doing our own work to, to kind of deprogram so that we can start to pass that on to the rest of our family as well.

Shireen: What advice would you have for someone who’s listening to this episode is either using that kind of language for a loved one or, you know, hears that kind of language from a loved one. What advice would you give to that type of person listening.

Dr. Smith: Yeah. So I think the first is to, to build empathy for, for the other person perspective. I think that in general we’re navigating family conflict. It’s important to first try to understand rather than defend or convince of our perspective for our family members. And if we can shift that about what fears or experiences or values might be contributing to some of these beliefs or, or language that my family is using that can help us come from a place of empathy from understanding rather than defensiveness, which in general can lead to some more trusting conversations, conversations that build more emotional safety because these are difficult conversations to have. 

And in that conversation, you might identify that there actually are some shared values, we might approach this differently, but we have some shared values. So how can we start there? Maybe rather than starting with the ways that we’re different? One thing that I do. So I have different values and perspectives on weight than a lot of members of my own family. And so I tend to just model my values through my behavior, through the language that I choose to use rather than maybe verbally directing my family to do something.

I also draw boundaries though where needed. So I tend to take a weight neutral approach and avoid any calorie or negative food or body talk. And so sometimes I just have to draw a boundary of I love that we both value health and wellness. I want to have these conversations, but when you talk about it with me, can we agree to avoid any talk about weight or calories? So drawing boundaries is totally ok with those conversations, if we need to protect your own mental health or our own triggers.

I also think just respecting everyone’s autonomy and making their own health decisions. Everyone values health differently and that’s something that is OK. And we have to sometimes release control if our family members value health in a different way than we do Change, that’s rooted in pressure or fear or shame is not sustainable, like I said, and so even when it’s really difficult to release that control, it’s important to just remember that we can’t shame or guilt our family members into changing their behaviors or valuing health in the, in the same way that we do or approaching health or weight in the same way that we do. 

So if we are modeling the way that we approach health modeling language, doing our own work on our relationship to our body image and food, that helps to just create a positive space for our family members to process these things or to make changes if and when they’re ready to. And so I think those are a few ways that you can sometimes approach those differences. If a family member is using language you’re not comfortable with or are just having different paradigms when you’re approaching health or weight.

Shireen: Lovely, with that, Dr Smith, we are toward the end of the episode. I feel like this, like I said, this, this, this time slot is just too short to go through all the different things. There is, there is quite a bit there. And at this point though, I would love for our listeners to know how they can connect with you, how they can learn more about your work.

Dr. Smith: So I write a lot about these topics over on my Instagram, Maggie’s Musings. So @Maggie_Musings and I’m sure that will be in the show notes. So these are conversations that you want to be a part of then join us over there. That was one of my favorite things to facilitate and write about how we can, we can find healing in these areas.

Shireen: So lovely, lovely. Thank you again for sharing that. And again, we’re gonna link up everything in the show notes so that folks listening here can click into it and get connected over to you. Thank you so much, Doctor Smith for being on the podcast and to our listeners, if you have personally experienced any instances where your family member or partners beliefs about weight has impacted your own head over to our social media.

Find this podcast post. Comment below and again, tell us that of how exactly if you or a loved one has experienced any instances of where family members, personal beliefs or your partner’s beliefs have impacted your own head over again to Facebook, Instagram. We’ll continue the conversation there and with that Dr. Smith, thank you.

Dr. Smith: Thank you so much for having me. I love this conversation.

Connect with Maggie Smith:

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