by Hannah Meier
“Love Your Tree.” It’s a directive inspired by Eve Ensler, the writer and activist behind the one-woman play, The Good Body (you may also know her as the playwright for the wildly popular Vagina Monologues). “Love Your Tree” is also the foundation of a creative arts eating disorder prevention campaign that started at the The Center for Eating Disorders at Sheppard Pratt in Maryland in 2006 and has since expanded nationally. Today, organizations across the country, including Massachusetts, are invited to participate in the 2018 campaign and submit artwork that illustrates body diversity, acceptance and positivity.
“Eve, look at that tree? Do you see that tree? Now, look at that tree (pointing to another one). Do you like that tree? Do you hate that tree ’cause it doesn’t look like that tree? Do you say that tree isn’t pretty ‘cause it doesn’t look like that tree? We’re all trees. You’re a tree. I’m a tree. You’ve got to love your body, Eve. You’ve got to love your tree.” (Excerpt from The Good Body, 2004 by Eve Ensler).
In the Baltimore-based Center for Eating Disorders at Sheppard Pratt, art therapy is a main component of recovery—helping patients approach body image struggles in a non-threatening way. Friedman alum, Christine Diven (Nutrition Communication, ‘12), assists with communications for the center where Julia Anderson, a Certified Eating Disorder Art Therapist created the Love Your Tree (LYT) Campaign in 2006. LYT is inspired by the metaphor in Ensler’s play, and is designed to cultivate an appreciation for the natural diversity of body sizes and help young people fight against society’s narrow and marginalizing standard of beauty and worth.
As someone who personally struggled with an eating disorder that stemmed from dysmorphic body image throughout my childhood and adolescence, I emphatically understand how important it is to build an acceptance and appreciation of all bodies—especially in childhood. With increased attention drawn to childhood obesity and even weight loss in youth, establishing a sense of body trust and acceptance in childhood is of the utmost importance for educators today to prevent the development of eating disorders for these kids down the road.
What We Know About Eating Disorders
Unfortunately, research on eating disorders is anything but well-funded. Current statistics estimate that between 0.5 to 3.7 percent of American women suffer from anorexia nervosa at some point in their lifetime, and about 1 percent of female adolescents currently have anorexia[i]. Bulimia nervosa affects an estimated 1.1 to 4.2 percent of women in their lifetime. Binge-Eating Disorder, one of the most recently codified eating disorders in the diagnostic manual for psychiatric illnesses, is the most common, affecting 3.5 percent % of women and 2 percent of men in the United States, according to the latest statistics[ii].
Clearly, these numbers are conservative, and they do not account for the millions of individuals who may suffer from disordered eating but do not meet one or more of the required criteria for a clinical diagnosis. These numbers also assume that those with eating disorders seek treatment, which is sadly not always the case. Also worth noting, most of our understanding of eating disorders comes from research conducted on women, since anorexia and bulimia are traditionally perceived to affect women more than men; however, men are no less likely to suffer from eating disorders[iii].
Dieting and disordered eating often come back to poor body image or a desire to alter one’s body to better fit societal norms, putting thinness above real physical health. Results from a 2008 Canadian study found that 40% of Canadian girls in tenth grade and 37% of girls in ninth grade thought of themselves as “too fat,” and 19% of those with a normal BMI considered themselves to be overweight. Twelve percent of those with a normal BMI admitted to trying to lose weight[iv].
Body dissatisfaction has a lot of other negative effects on kids and teens beyond increasing the risk for developing eating disorders. Some studies have shown that when students feel badly about their bodies, their GPAs are likely to be lower than students who don’t feel badly about themselves. And while we might think these types of issues arise in adolescence, body dissatisfaction and body anxiety may begin as young as second grade across varying racial and ethnic backgrounds, in both boys and girls.
How does Love Your Tree fight back?
According to current program director Brianna Garrold, the LYT campaign is currently in its 12th year. It was originally structured for middle and high school students in the Baltimore and surrounding area, but now reaches outside the state with organizations in New Jersey, Massachusetts, and Connecticut. Schools and organizations that host programs invite students to submit artwork representing their response to the Tree metaphor.
The campaign is even expanding overseas and across age groups. “In 2014, an organization in Australia picked up the message and contacted the creator of the program for more information about LYT and tips for hosting their own show and awards ceremony,” Garrold explained. “Over the years, Love Your Tree has expanded to include college students, and as of 2016, kindergarten and elementary-aged students. LYT has also started branching out beyond school-based workshops and into community organizations as well.”
For school participants and eating disorder patients alike, the metaphor of a tree helps to explore healthy body image and self-image in a non-threatening way. According to Garrold, art therapy often feels “easier and safer” for participants than other approaches.
What are the common risk factors we can focus on to prevent eating disorders?
Garrold points to the biopsychosocial model of development—an understanding that biological, psychological and social factors all can play key roles in determining whether someone will develop an eating disorder.
“Unfortunately, we live in a society that is comparative, image focused, and perfectionism driven—all things that fall under the ‘social’ part. Body dissatisfaction and body anxiety are beginning at younger ages due to exposure to these messages, and as our society becomes more connected and ‘plugged in,’ it is getting seemingly harder to ignore them,” she says. Frequently, comparison to peers and media influence are major factors that contribute to the development of low self-esteem and poor body image.
“It can feel like an uphill battle to help reach out and provide support for kids,” Garrold admits. “Keeping an eye out for warning signs, like social withdrawal, critical or comparative comments about or related to peers or celebrities, fixation on being ‘the best’ or feeling the need to be perfect, [and] fixation with weight or food can offer insight into areas kids and teens might be struggling with.”
What can we do in Massachusetts to get involved?
Garrold invites those of us outside of Maryland to participate as an out-of-state chapter, especially if we work with students or young adults. “Outreach programs like Love Your Tree are designed to combat negative messages by educating students about the effects of the media on self-esteem and body image. Allowing space and time for conversation around topics like body image can be empowering for students […] and providing education about media literacy (understanding some of the dynamics of advertising, [and] the use of photo alteration programs) is a great topic to include as well.”
Even if we can’t fully participate fully in LYT, the website offers resources and support, and Garrold stresses that the most important part is to help kids feel like they have someone to talk to and activities to engage in. She recommends the online gallery at www.loveyourtree.org to spark the conversation.
“Our culture seems to spend a lot of time discussing criticism and flaws and not enough time discussing successes and positive attributes. Encouraging kids and teens to get involved in activities they enjoy, engage with peers, feel comfortable and safe enough to explore their talents, and celebrate what makes each individual unique are all ways we can help foster healthier students, which in turn, fosters healthier communities. The hope is that starting on a small scale will snowball into larger messages of healthy self-esteem and body acceptance.”
Bringing it back to Friedman
As part of a school focused on nutrition science and policy, we are well aware of the health challenges our nation faces, and the role proper nutrition can play. Decades of research associating overweight and obesity with increased risk for disease and lower quality of life has called us to lead the crusade for health—to prevent or reduce overweight and obesity by empowering individuals and communities to prioritize nutrition and its downstream health benefits. We know that obesity and disease disparately affect those of low socioeconomic status, and understand that it takes a multi-pronged intervention to make a dent in reshaping a community.
But have we been paying enough attention to weight stigma? The American Academy of Pediatrics very recently released a policy statement about weight stigma experienced by children and adolescents with obesity, which is a must-read for anyone working with this population (likely all of us, in some regard). In it, they point out that weight stigma is widely tolerated because our society believes it will motivate people to lose weight, despite its counterproductive contribution to behaviors such as binge eating, social isolation, avoidance of health care services decreased physical activity and ultimate accelerated weight gain over time[v].
Instead of focusing on reversing weight gain trends, perhaps we should focus on reversing the plague of weight stigma. Health behaviors exist outside of body mass index, and focusing wholeheartedly on weight has proven to be undeniably ineffective, and perhaps harmful, in cultivating healthy behavior change[vi],[vii],[viii].
As Garrold encourages, “helping establish a healthy (or healthier) self-image is essential to prevention of and recovery from eating disorders.” Everyone can benefit from feeling more connected to and proud of their body.
If you are interested in getting involved in the Love Your Tree campaign, visit www.loveyourtree.org for more information. The 2017-2018 campaign is NOW OPEN and accepting poster submissions from students of all ages. Visit the website to view past submissions and learn how to submit an entry.
Hannah Meier is a Registered Dietitian, second year Nutrition Communications student, aspiring eating disorder specialist and an advocate for healthcare that does not stigmatize based on weight. Her favorite ways to honor her body include twisting and balancing in yoga poses and wearing extra soft pajamas as often as possible.
[i] The Renfrew Center Foundation for Eating Disorders, Eating Disorders 101 Guide: A Summary of Issues, Statistics and Resources, 2003.
[ii] Hudson, J., Hiripi, E., Pope, H., & Kessler, R. (2007) “The prevalence and correlates of eating disorders in the national comorbidity survey replication.” Biological Psychiatry, 61, 348–358.
[iii] Strother, E., Lemberg, R., Stanford, S. C., & Turberville, D. (2012). Eating Disorders in Men: Underdiagnosed, Undertreated, and Misunderstood. Eating Disorders, 20(5), 346–355. http://doi.org/10.1080/10640266.2012.715512
[iv] Boyce, W. F., King, M. A. & Roche, J. (2008). Healthy Living and Healthy Weight. In Healthy Settings for Young People in Canada.
[v] Pont, S. J., Puhl, R., Cook, S. R., & Slusser, W. (2017). Stigma Experienced by Children and Adolescents With Obesity. Pediatrics. Retrieved from http://pediatrics.aappublications.org/content/early/2017/11/16/peds.2017-3034.abstract
[vi] Thompson JK, Stice E. Thin-ideal internalization: Mounting evidence for a new risk factor for body-image disturbance and eating pathology. Current Directions in Psychological Science. 2001;10(5):181-3.
[vii] Pelletier LG, Dion SC, Slovinec-D’Angelo M, Reid R. Why do you regulate what you eat? Relationships between forms of regulation, eating behaviors, sustained dietary behavior change, and psychological adjustment. Motivation and Emotion. 2004;28(3):245-77
[viii] Bacon L, Stern JS, Van Loan MD, Keim NL. Size acceptance and intuitive eating improve health for obese, female chronic dieters. Journal of the American Dietetic Association. 2005;105(6):929-36.