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Taking Our Place at the Table as Citizen Scientists and Clinicians

By S. Bryn Austin

Imagine a world where girls, boys, and children of all genders believe in themselves. A world where they are willing to speak up to share their ideas, speak out when they see something unfair, and step in to lead to make positive change in their communities and lives.

This is a world we want children of all genders to be able to take for granted someday. A world where they grow up never questioning that not only are their ideas and leadership valued but also seen as essential for a community to thrive. A world where children of all genders can grow up at home in their own bodies and their own communities.

But for too many children, they learn they are not good enough, that their bodies are shameful. They learn they must spend their days dieting, constantly comparing themselves to society’s distorted ideals of beauty in magazines and social media. They learn to take diet pills and laxatives masquerading as “detox” cleanses, which they can buy legally in stores or online in most places around the world -- despite the known dangers. For children of color, especially girls in the Global South, they learn to hide their skin from the sun, lest they get darker and further from colorist beauty ideals, and to use toxic and sometimes carcinogenic skin lightening products.

They learn to be Houdinis, experts at hiding themselves and who they are. Too many children are sitting on the sidelines, disempowered and struggling with low self-esteem and poor body image. Some will go on to develop potentially life-threatening eating disorders. 

So how did we get to this place, so far from the world we dream? Everywhere they look, children see images of models held up as the ideal of beauty and status. They are lionized for being trim or buff, for being of light complexion with white European features, without regard to the costs to mind or body of striving for a distorted ideal that is unachievable for most – including the young models themselves.

Adding insult to injury, in most nations of the world – with the exception of France and Israel -- there is rarely any acknowledgment of the advertising photo editor’s manipulation of images, which often makes models’ images so unlike their true form that even their own parents may not recognize them. And weight discrimination is relentless in media, schools, and workplaces. It is especially harsh in the lives of girls and women, who bear the brunt of this unfair treatment. But like selling toxic diet pills, laxatives, and skin lightening products and deceptively manipulating advertising images, weight discrimination is legal in much of the world.

How can children reach their full potential when the deck is so stacked against them? With our help. That help is already coming from our many dedicated AED members working as clinicians, researchers, and educators. But that is not enough: It must come from us acting as “citizen psychologists” – to borrow the term coined by my friend and colleague Jessica Henderson Daniel, Immediate Past President of the American Psychological Association (APA), for the organization’s trail-blazing civic engagement initiative. To be more inclusive of AED’s diverse professional membership, we can call ourselves “citizen clinicians” or “citizen scientists.” If we join forces together with other health professionals as committed to health equity as we are and also join with children, parents and guardians, community and business leaders, and policymakers, we can re-stack that deck. We can move hearts and minds and empower children of all genders to believe in themselves, fight back against the weight and appearance shaming bullies, advertisers, and opportunists, and join others in changing our world.

The old adage to think globally but act locally is as true for this as any other critical issue of our day. Within our community of eating disorders professionals, we need to take this adage to heart.

The APA’s Dr. Daniel implores and inspires her fellow psychologists to engage in the world: “Almost every aspect of human existence is impacted by psychological science, education and practice,” Dr. Daniel writes. “And almost every social policy can be informed by it. For these reasons, I firmly believe that psychologists and psychology students need to be in more rooms, at more tables, and at the heads of those tables when decisions affecting the public are formulated and implemented.” Our organization may be global rather than national and made up of diverse professions, not just psychologists, but Dr. Daniel’s wise words resonate just as well for us.

As representatives or as a voice from the world of eating disorders science and evidence, we need to be at the table with community leaders and advocates to build toward innovative, evidence informed policy solutions. Working in close partnership with policymakers and communities, we can help to bring young people and their champions together to change the culture and change policy to create a healthier environment for children of all genders to grow and thrive.

All around us, we are seeing evidence-informed policy initiatives picking up momentum. Important victories are being won to reduce noxious weight and appearance pressures in media and consumer environments, end outright discrimination in workplaces and education, and put limits on the weight-loss and skin-lightening product industries’ ability to exploit children’s body insecurities for profit.

For example, in June the U.K.’s advertising watchdog Advertising Standards Authority issued new rules restricting ads that promulgate grossly stereotypical gendered portrayals, citing research documenting the psychologically harmful effects on young people in ways that “restrict the choices, aspirations, and opportunities” they experience. A related issue of “photoshopping” or digitally altering ad images to conform to damaging and unrealistic beauty ideals has long been a subject of study in our field, with strong evidence linking ubiquitous exposure to these types of images in media to increased risk of body dissatisfaction and eating disorders symptoms. While a U.K.-style ban on these images may be tempting, in the United States, federal free speech rights make such a move likely to be held unconstitutional and therefore a nonstarter. So in Massachusetts, a bill introduced in the state legislature this year takes a different tact by rewarding companies with tax incentives for not digitally altering ads in this way.

In July California became the first U.S. state to ban discrimination in the workplace and educational institutions based on natural hairstyles in order to address this widespread form of racist appearance discrimination particularly targeting African-Americans. New York and New Jersey are on the cusp of adopting similar laws in their own state legislatures. In May social media protests in India made headlines around the world when advocates called out the hugely popular Miss India contest and local press for lightening contestants skin tones to impose a more white European standard of beauty. The #unfairandlovely campaign and like-minded advocates drew needed attention to the damaging body image pressures on Indian youth and condemned the opportunist companies that sell toxic skin-lightening creams to consumers of all ages. In Africa, several nations have already banned skin-lightening products, including Ghana and Rwanda.

Research on weight discrimination and stigma have clearly shown they are widespread and strongly linked to negative health consequences, including increased body dissatisfaction and onset of eating disorders symptoms. But weight discrimination is also almost universally legal. Only one U.S. state and a handful of cities ban this type of discrimination, but new bills in Massachusetts and New York seek to expand protections to their states too, and discussions have begun in Germany and Iceland to do the same. Similarly, evidence-based policy initiatives are taking on the weight-loss products industries that sell dangerous products with deceptive promises of weight loss to children and consumers of all ages. Bills currently being considered by lawmakers in New York City and Massachusetts are informed by strong research evidence linking the products to acute and long-term health risks and to eating disorders.

All of these policy initiatives to address destructive weight and appearance pressures in our social and consumer environments are based on solid evidence. It’s worth noting, though, that this is most definitely not true of policy initiatives in many other arenas. So, what are we doing right? Having scientists involved in the process of generating and vetting the evidence needed to develop sound policy and working closely with advocates and lawmakers through the advocacy process to ensure that success is achieved is one right thing. This is how it’s done, no mystery here.

The challenge for us is that most eating disorders professionals – and most clinicians and scientists more generally -- do not receive much of any training in graduate school or post-graduate courses on how to engage in policy advocacy. In fact, the dearth of such training is exactly why the APA launched its Citizen Psychologists initiative, to begin to address the gap in this critical training need. Perhaps the prospect of giving policy advocacy a shot seems daunting because of the seemingly never-ending demands on our time as clinicians and researchers. Or perhaps to some members it even seems to run counter to the role of scientists in upholding standards of objectivity.

To be sure, these are fair concerns, but consider this: Many health professional societies, not just the APA, include in their ethical standards that their members should view civic engagement as among their basic professional obligations. Why? For two main reasons: One, because protecting and improving the health of our patients and of communities, especially those with the least resources and access to power, often requires that policies or gaps in policy that adversely affect their health and life chances be replaced with ones that will redress these inequities. And two, any policy changes designed to affect health must involve clinicians and researchers who can lend their expertise to weighing the evidence for or against certain policy strategies and conducting research to evaluate any policy initiatives for intended and unintended consequences. Just as Dr. Daniel argued for her members to be present at every stage of the process, we, as eating disorders professionals, need to take a seat at the table of decision-makers to ensure important issues are prioritized and that policy initiatives are evidence-based and subsequently evaluated.

Our goal as citizen clinicians and scientists? To engage with communities around the globe in policy advocacy to catalyze change and create healthy environments. Together we can make impactful culture and policy change happen to help young people feel good about themselves, at home in their own bodies, and empowered to lead one day themselves. Children of all genders should have a chance to reach their full potential.