Episode 14. Today I had the pleasure of talking with Dr. Afton Koball, a board certified clinical health psychologist with a wealth of knowledge in the areas of behavioral weight management, bariatric surgery, weight bias, motivation, and many other related areas. She obtained her PhD in Clinical Psychology from Bowling Green State University and did internship at Rush University Medical Center and fellowship at the Mayo Clinic.
What to Expect in this Episode
We dive into a lot of topics with Dr. Koball including but not limited to:
How she got interested in health psychology and the weight management fieldHer difficulties at times with accepting her post-partum bodyWhat is weight biasHow Dr. Koball would like to see the field improve as it relates to recommending weight loss surgeryWays to improve your relationship with food from an evidence-based approach
Who Struggles with Body Image (Pretty Much, Everyone)
Afton talks about some of her struggles with accepting her body after her third kiddo, even when she feels she "knows better" and knows self-critical thoughts aren't helpful.
On How We Are Doing as a Field with Helping People Lose Weight
"I think we are doing such a crappy job. I think we have perpetuated this idea in the media and popular culture and unfortunately even in healthcare that weight loss is all about diet and exercise so if you just eat less and exercise more you will lose weight. And if you aren't losing weight, then something is wrong with you, you're bad or you aren't working hard enough or you are lazy." (In reference to how we are doing as a field with regards to helping people lose weight)- Dr. Afton Koball, PhD, ABPP
That pretty much sums it up! Just kidding, we dive into more details in the episode.
She talked about how it of course is not bad advice to eat well and move more, but that weight is so much more complicated than we lead people to believe. She mentions our environment, physiology, our stress and yet we pin it all on diet and exercise.
What Aren't We Talking About
Dr. Koball talked about how much we emphasize "diet and exercise" as the end all be all and we rarely talk about all the other contributors to weight, like physiology, genetics, environment, stress and so many other factors.
Metaphor of Trying to Slow Your Respiratory Rate
She talked about a metaphor equating large amounts of weight loss to trying to slow down your respiratory rate. She talked about how it is possible for a period of time, but since your body was not designed to do that it takes a lot of willpower and effort and energy and you aren't able to focus on much else.
What is Weight Bias?
We talked about weight bias, which is negative attitudes and stereotypes about people solely due to their weight or body size. And how in some ways we are more stigmatized against larger bodies than every and it can still be one of the more socially acceptable forms of bias.
She discussed weight bias and its association with negative physical outcomes (e.g., weight gain over time, increased stress hormones) and the importance of sharing this information with people, particularly medical professionals.
She talked about even when controlling for all other factors, weight bias still is predictive of early mortality (Sutin, Stephan, & Terracciano, 2016).
The Way We Approach Weight Loss Undermine Key Psychological Needs for Long-Term Change?
Undermining Competence (Feeling effective, "I can do what I set out to do") and Autonomy (Freedom from excessive pressure to behave in a certain way)
The messages that a one size fits all works for everyone. This can be particularly problematic for people of higher weights, with medical conditions, or who are debilitated by their weight.Focus on what not to do makes people want the foods more.
What Do We Think about the Body Mass Index?
We talked about the very limited utility of BMI.
