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Session 204: Some Thoughts On Body Image

The Therapy for Black Girls Podcast is a weekly conversation with Dr. Joy Harden Bradford, a licensed Psychologist in Atlanta, Georgia, about all things mental health, personal development, and all the small decisions we can make to become the best possible versions of ourselves.

Our relationships to our bodies can often be complicated. Messages we get from society, family, and the media often leave us frustrated with our bodies and can lead to unrealistic expectations. To help us get a little clarity in this area, today we’re joined by Paula Edwards-Gayfield, MA, LPCS, LPC, NCC, CEDS-S. Paula and I chatted about how our perceptions of our bodies are formed, how those perceptions have been shaped during the pandemic, what it looks like to have a more connected relationship to our bodies, developing healthy ideas about nutrition, and she shares some of her favorite resources.


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Session 204: Some Thoughts On Body Image

Dr. Joy: Hey, y’all! Thanks so much for joining me for Session 204 of the Therapy for Black Girls podcast. We’ll get into the episode right after a word from our sponsors.


Dr. Joy: Our relationships to our bodies can often be complicated. Messages we get from society, family and the media often leave us frustrated with our bodies and can lead to unrealistic expectations. To help us get a little clarity in this area, today we're joined by Paula Edwards-Gayfield. Paula is Regional Assistant Vice President at The Renfrew Centers and holds licenses as a counselor and supervisor in both Oklahoma and North Carolina. She's a certified eating disorder specialist and approved supervisor and is a co-chair of the African American Eating Disorders Professionals Committee.

Paula and I chatted about how our perceptions of our bodies are formed, how those perceptions have been shaped during the pandemic, what it looks like to have a more connected relationship to our bodies, developing healthy ideas about nutrition, and she shared some of her favorite resources. If there's something that resonates with you while enjoying our conversation, please be sure to share with us on social media using the hashtag #TBGinSession. Here's our conversation.

Dr. Joy: Thank you so much for joining us today, Paula.

Paula: Thank you, thank you. I appreciate being here.

Dr. Joy: In Session 165 of the podcast, we had your colleague Dr. Brooks on just to talk about how the pandemic has triggered disordered eating for people. And here we are a year later (almost a year later) and so that commentary around like our bodies and eating and what people have done to kind of manage themselves throughout this time, that conversation has not gone away. So I'd love to just kind of hear from you what kinds of things you've been seeing in your work, related to the pandemic and people in terms of like body image and eating.

Paula: Such a great question and you're right, like to think about it a year later. I travel for my job a lot so I've been grounded actually since March 11, 2020 so it's sort of when this time came around, that was something for me that stood out. But yeah, we're continuing to see increases in eating disorders. More individuals seeking treatment because of access to care with the telehealth services, but also just continued messages around body image, body image concerns, increased mental health concerns in general. And so we're seeing a lot more people really struggle with body image, I think in many ways because they're constantly on Zoom and whether it's school or work related, even being in treatment with us, and sort of that greater opportunity to pick themselves apart in many ways.

Dr. Joy: Yeah, it definitely seems like I have seen now that more people are getting vaccinated, there's been like lots of conversations around people in their summer bodies and like getting their bodies ready to be seen again, maybe. Can you share anything that has come up for you around that?

Paula: We've not heard it too terribly much but you're absolutely right. I think this is that time of year where people are working to think about I gotta be in shape. Summer bodies, I think, is a great way to state that because they're looking at spring break just passed, the summer is coming up. And you're right, more people getting vaccinated are absolutely preparing for returning to “normal activity” that they would have done pre-pandemic. And so yeah, definitely the conversation around body image, as you can imagine, never really goes away, it's something that people struggle with all the time. It's just that continued increase, being bombarded with messages. And again, looking at if they did gain any weight over the pandemic (and being sort of stuck in their homes) then absolutely the desire to lose weight and focus on appearance continues to increase overall.

Dr. Joy: You bring up a really good point, Paula, in terms of like these conversations never really going away. And I wonder if we can kind of start from the beginning, just in terms of like how do we even develop our body image? Where do some of those messages come from, like how early is that developed for us?

Paula: Oh, my goodness–birth. I think that body image is so complex. I think even though we may or may not be opening up to those messages at birth, it really does start at birth and it shifts over time throughout various stages of life. You know, body image, we think of that as how you see yourself, your feelings about your body, how you feel in your body, but also how you believe others see you. And so if you can imagine, if all of those things really influence body image and body image development, then the factors that are contributing to that are both internal and external. That can be our culture and ethnicity, but also who are the people in our lives? What are the messages that we receive from peers or family members or just our daily groups that we engage in, that really do influence our attitudes and values that maybe we're trying to conform to? In addition to just our own perceptions and attitudes and beliefs about body image.

Dr. Joy: Yeah, and we know pop culture and movies and TV and all of those things really impact like how we see ourselves, especially as black women.

Paula: Absolutely. And we are talking about body image especially with black women. We're talking about appearance overall. So that's going to be not just thin (so to speak) but we're incorporating height, shape, weight but also some memories could be contributing. Our assumptions, our generalizations, we know about looking good with black women and people of color. But then also hair, complexion, all of these things are factors for black women when you think about body image.

Dr. Joy: Yeah, and something that we haven't really talked about and I'm wondering if this is something that you work with a lot in your work, Paula, is body dysmorphic disorder.

Paula: We do. It's definitely looking at individuals. I would say we probably have more individuals that are just presenting with body image concerns than body dysmorphic disorder but, yes, we do see it. And really, with body dysmorphia, exploring that there is still just something wrong, that they truly do not see themselves the way that other people see them. And I know there seems to be like a slight... Sort of like, what's the difference?

If I don't see myself the way others see me (just having general body image concerns) versus body dysmorphia. When I think about body dysmorphia, it's more like there's something flawed. It truly is distorted or wrong or flawed in some way, that there's this constant desire to fix it. And that's where you may see people doing not just diets and things like that but plastic surgery. They're working to fix and repair the flaw.

Dr. Joy: Hmm. You know, Paula, I feel like I had a conversation with someone probably a couple of months ago around (since you bring up the idea of plastic surgery), like is it ever within range to do plastic surgery? Like are we always looking at something that could be considered like a body image issue?

Paula: It's interesting because as you're saying that, I think about family members and friends and people that I know who have had some form of surgery or enhancements or corrections, if you will. And so I think it's definitely much more accessible to black women now. That then whether it's a liposuction or a tummy tuck or trying to think like all of the terms when people are getting their hips enhanced or their lips, I think there's so many ways that people are constantly trying to improve themselves and to create a sense of looking good and looking better. And so what are the adjustments that they then make?

I think that because black women may adopt like a thicker figure, even though they still want to be slim–like a thin stomach or slim abs but being okay with curves–that's where that accentuating some of the things that result in me looking good or that individual looking good. That they may, you know, engage in some sort of... whether it's actual surgical or non-surgical enhancements.

Dr. Joy: Mm hmm. And I guess the real question is always like really questioning your intention and understanding where those decisions are coming from for you.

Paula: Yes, absolutely it is. Especially when you go back to body image and thinking about how do other people see me or how do I see myself? It really becomes that what is the influence on my own thoughts? How do I really embrace and accept this is who I am? And it's not me trying to make changes based on maybe other people's comments or other people's beliefs about how my body should or should not be. I sometimes say to clients that we work with, like, what is good body image? And I'm like I don't really know what is the answer to that.

And I will sometimes say to them, good body image: I woke up this morning it’s like, “huh, okay, I look good,” and I keep it moving and I don't worry about anything else. I'm able to do my job and it's not a factor for the rest of the day. Or tomorrow I can wake up and think “ugh!” I get dressed, I get to work, I do what I need to do and I don't think about it the rest of the day. It’s not influencing my work, how I feel about myself. It's just acknowledging that today I think I might look good, tomorrow not so much. And that is really how I think about what good body image is. And again, that's my view of this. But if we're not able to view it in that way versus we are constantly changing, it's impacting our emotional state, it's impacting our relationships or our responsibilities, that's when we have to think about what's going on. That this is something deeper than just dissatisfaction today.

Dr. Joy: You mentioned that one part or one thing that can impact our sense of our body image is memories. Can you elaborate on that a little bit more?

Paula: Yeah. I definitely think, even if we think about intergenerational trauma, I absolutely believe that there are intergenerational and historical influences on a black woman's body so I think that's why it is complex in many ways. Kind of thinking about how going back to slavery where a larger body size, even though we know that there are the archetypes that were present like with the mammie, but also there was this sense of being linked to like fatness or being greedy or lazy as Africans, and that they needed to be disciplined and controlled.

Also, we know that black women's bodies, going back to slavery again, were treated as being in excess and so I think that that's something that absolutely can be passed on. But also when you're thinking about memories, what are some of the things that happened along the way developmentally? And I don't know that sometimes those things are always over experiences. They could be things where maybe I've never even told anyone about or this message that I heard or even the messages that I heard my family make about their own bodies. And thinking, okay, if I look like Aunt Tina and I hear people comment about Aunt Tina's body, how might I adopt those things? And those become some of the memories, I think as well, that really influence and shape how we see ourselves as individuals.

Dr. Joy: Mm hmm. I really appreciate that context because, you're right, I think it is often a very complex kind of situation. It's definitely not as easy as telling somebody to stop doing that. Like there are lots of layers that need to be explored here.

Paula: Agreed. Also, just thinking about as you're saying that, I keep going back to body image for black women is not about thinness. And I think we continue to sort of have to educate others and fight this fight, so to speak, that it's not just a black woman may embrace a larger body type. It's just that our standards (I guess, I would say) for black girls developmentally or the standards for black women overall are just different from that of white women, in terms of a preferred body type.

Dr. Joy: Why do you feel like it's important to make that distinction?

Paula: Because if the standard of beauty is focused on this uniform picture that's been established by a white sort of social construct of beauty, then you're going to be missing the mark. But then also, I think, to sort of generalize black women as just all of them are accepting of a thicker figure or a larger body type, again, you're missing the mark.

And so I think that it's important to know that even though black women may select larger body silhouettes (it's been documented in studies) it's more based on, in general, black people versus white people may think about body image or just acceptance of body type at a larger BMI. And so they're not looking at that thin ideal, they're not looking necessarily at that standard of beauty that was developed from this white social construct. And that's the part that I think that clinicians, all clinicians, really need to be aware of. Otherwise, there could be some contradictory messages that are occurring.

Dr. Joy: That is such an important point. I'm glad you shared that. Yeah, because if you are a white clinician or somebody who's not in tune with all these cultural pieces, you may miss that I may have like some disordered eating because I seem fine with my curves.

Paula: Absolutely.

Dr. Joy: I know that you also recently contributed a chapter to the Treating Black Women With Eating Disorders: A Clinician’s Guide. Can you tell us about your chapter?

Paula: Yes, thank you. The chapter focused on binge eating disorder and shame. Overall looking at eating disorders amongst black women and binge eating disorder in particular, but really focusing on that sense of mental health being taboo growing up. I'm in my 40s so in the chapter I kind of go back thinking about personal experiences or the messages personally but then also in working with women of color. So just that acknowledgement that 40 plus years ago (and still today in many ways) mental health was not talked about, let alone the thought about eating disorders.

And so just thinking if someone was struggling with any sort of depression, anxiety or an eating disorder, who would they have turned to? And so how it becomes this great sense of shame–that I'm struggling with something, that I'm weaker than maybe my peers or my siblings. And so that's one of the messages that I really wanted to sort of put out in the chapter. That focus on shame and then what that really does to us. And how shame not only influences disordered eating but also how shame influences body image and just general sense of self, again then reinforcing probably some increased depression, anxiety and other mental health concerns as well.

Dr. Joy: Mm hmm. Yeah, so this whole idea, especially 40 plus years ago, we weren't talking about therapy. Well, we definitely were not talking about eating disorders. I don't even know, you may be able to give us a better sense of a timeline, but at what point it even became recognized that black women actually did struggle with eating disorders. Because for a long time, and I think still some of this is in the narrative around like, “oh, that's not something black girls struggle with,” like only white girls get eating disorders. So I think our timeline is even later than the general population in terms of discussing these things.

Paula: Mm hmm, yeah. In terms of exact dates, clearly, I don't know that but absolutely. You know, I've been with Renfrew for almost 14 years and when I think about when I first started, I was not seeing... Not only providers that looked like me, but definitely no patients that looked like me. Even when we did have a patient, it was the rarity. I'm grateful for telehealth services now that we're able to connect more people of color amongst our system at Renfrew but even still, you might have one or a few because there is still so much stigma.

The eating disorder still doesn't even occur within. It may be more binge eating disorder versus anorexia or bulimia, and black women get all eating disorders. But I do think about eating disorders have definitely been present. I don't know if I’ve shared this in the chapter or not, but I can even recall growing up, my grandmother used laxatives all the time, like every single day. And when I think about how we might characterize bulimia even now or even a subclinical diagnosis of an eating disorder, might I have considered her having some disordered eating with utilizing laxatives? I think we miss the things that black women may do or engage in that are absolutely still disordered behaviors.

Dr. Joy: More from my conversation with Paula right after the break


Dr. Joy: Can you share other things that might be missed?

Paula: Definitely the laxatives, even though I realize that all individuals who engage in eating disorders may utilize some of these. But yeah, diet pills, laxatives and diuretics would be up there at the top for me as I think about people who are black individuals. When I think even historically or even when I think about people that I know that know people and know what I do, and they sort of talk and explore “is this a problem?” So diet pills, laxatives and diuretics are absolutely something that the frequency may not meet the criteria for a diagnosis of an eating disorder, but if you're talking about this is something that's disordered behaviors and that could somebody start to seek some help around? Absolutely. I think this is where we're missing the mark.

I recall reading a few years back where what if individuals who could have been diagnosed with maybe a binge eating disorder or subclinical eating disorders were missed because the focus was just on health and weight, and that they just needed to lose weight. That did any of those individuals then start to engage in other behaviors, whether it was the purging, via (like you said) putting your finger down your throat or maybe they started restricting more? What if we would have caught some of these disorders or these behaviors beforehand, what would the frequency be of eating disorders amongst various populations?

Dr. Joy: Yeah, I mean, I think it's probably safe to say the numbers are not super accurate.

Paula: Absolutely. Because we're also still taking the numbers based on who's reporting, you know, this is just on who’s seeking treatment in general. I think other behaviors that could be still subclinical again, maybe they're exercising or over exercising. Even though I realize we're talking about exercise and black women–that's kind of always been a thing and with respect to health. But exercise is an appropriate behavior. People encourage people to exercise, that's just being heart healthy. And so I think that behaviors that individuals believe are okay, this is what's getting missed. Dieting just in general. Even when I think about the intermittent fasting, this is something that could be... is this a gateway, is it sort of some subclinical behaviors, but yet it's socially acceptable.

Dr. Joy: That was on my list to bring up, Paula, but you have already brought it up so let's go there. I don't quite understand what intermittent fasting is but in paying attention to the landscape from people who use a Health at Every Size model, it seems like people are not excited about this, like people in your field. Because it does feel like there is some concern, so can you say more about what intermittent fasting is and why we might want to be careful with it?

Paula: Essentially it is dieting if we were to just be honest. It still is dieting. Intermittent fasting is, depending on the plan that an individual is following, they're only allowing themselves to eat during a specific time. And that could be for a certain number of hours each day, it could be eating like the number of meals a certain number of days a week, but the intent is to burn body fat. So when you're looking at (it) there are multiple plans or recommendations as to how someone may engage in an intermittent fast.

And again, they're not doing it for religious purposes. For example, someone might only eat during an eight-hour period each day and then they're fasting for the remainder of the day. Or they could choose to eat only one meal a day like two days a week and then they’re fasting and increasing fluids for a few days a week. And then they would resume and sort of go back and forth and so it's just really that contrast of what normal eating patterns may be for most of us when we're awake. But again, it's a diet and it only works by prolonging the period in which your body has burned through the calories consumed from your last meal and then it starts to burn fat.

Dr. Joy: And who is coming up with like the plan for whether you do only within an eight hour versus like only eat every two days? I'm guessing this is not happening with a physician or somebody like guiding.

Paula: I hope not but it could be. And I don't want to say that it definitely is but just if there are some individuals who are encouraging or prescribing diets that are medical professionals, this could be a way that they're also prescribing a diet. In terms of who's coming up with the how and what, that's something, Joy, I really don't know. I do know that there's always the recommendations of “check with your doctor before starting any diet program.”

They're saying the same thing about even starting the intermittent fasting because there are so many approaches to doing it, they just say you can pick like a daily approach, you can explore what might happen. There's like a 16:8 which is like I mentioned about the eating for eight hours fasting for 16. There's another approach that's like a 5:2 approach where you could eat regularly for five days a week and then the other two days, you're limiting yourself to one 500–600 calorie meal. There are so many plans, even stretching out the period of time without food anywhere from 24 hours to 72 hours. As you can imagine, that can be dangerous for us.

Dr. Joy: What is dangerous about it?

Paula: Because your bodies still need fuel. When you are thinking about fuel and energy, this is what all of our bodies need and I think that going too long without eating can actually encourage your body to store fat in response to starvation. But also, if you're thinking about somebody who already may be medically compromised, is this then what your body needs? Because keep in mind, they're fasting to get to the point of where their body is now starting to burn fat and so for each of us we don't know what that time length is going to be.

Dr. Joy: Yeah, and this is where you get into the territory of like really messing up your hunger cues and so then your body is not indicating to you when you actually do need more fuel.

Paula: Absolutely. And then if you're prone to develop an eating disorder, just imagine that then now have you kind of set something off there with the temperament vulnerability in terms of who develops it. But you're absolutely correct, hunger and fullness cues are so vital to any of us. If we're talking about normalized eating in general, we want to be able to incorporate like variety, balance, moderation, but also pleasure. We want to consume foods that we enjoy. And so if we're working on that and being a more intuitive eater and having a healthy relationship with food, that's the approach to take. That's where you want to be able to sort of work things out versus this diet approach.

Dr. Joy: Mm hmm. Can you say more about that, Paula? How we actually do develop a healthy relationship with food. Intuitive eating is also something that I've heard people talk about; can you say more about that?

Paula: Oh, wow. The way I think about how do you develop a healthy relationship with food and going back to anybody with kids... Not that everyone does this so let me not make a blanket statement. But understanding that we don't want to pressure people to eat. Now, again, that's outside of the eating disorder. We're not talking about people who have eating disorders, but recognizing that pressuring individuals to eat is not necessarily going to be a good thing.

So when I think about developing a healthy relationship with food, it really starts with what are our food beliefs? What do we believe about food? Really not holding on to sort of this good/bad food beliefs. Really being able to let go of diets and diet approaches and just acknowledging that all food’s food. So that's really going to be part of it. But that part of it is ongoing because we're bombarded with messages. But as you develop that healthy relationship with food, acknowledging that food is life, we all have to have it, it's all going to be in common and so if we're utilizing food for survival, then what does that look like?

Also acknowledging that different people have different needs and food preferences. And so sometimes that's going to be biologically driven but other times it's just our taste buds and what we like or dislike. And so I think that's where the acceptance and variety and really not falling into this about what's good or what's bad. It's also identifying, is there any sort of emotional activity or emotional connection to what we're eating, why we're eating and even maybe the how we're eating? And so increasing our understanding of that as well in the process of working on developing a healthy relationship with food.

Dr. Joy: Mm hmm. More from my conversation with Paula right after the break.


Dr. Joy: Yeah, and I wonder if you can say more about... Kind of earlier, we started this conversation but I'd like to go back to just the whole entire body positivity movement. Do you have thoughts on like the current evolution of what that looks like?

Paula: You know, yes. I think what it is intended to do, I think it's great. I really do. I think the intention is great, that it's about acceptance of all bodies–regardless of physical ability, size, gender, race, appearance. I think if we could hold on to that, that would be amazing. I think that it also has the concept that all people deserve to have a positive body image, regardless of what society and culture believes an ideal shape or size and appearance needs to be.

Where I struggle with body positivity is that I think that we have to also think about racial diversity. And we really have to think about like how do we have these movements that focus on one aspect of something like body positivity? But maybe are we also acknowledging that there's some anti blackness somewhere as well? Are we accepting of other social movements? Are we accepting of people in general? And I think that's where if we're focused on body positivity, we also need to be focused on racial equality as well.

Dr. Joy: Yeah. And I've also seen commentary just around like maybe people won't actually feel positive about their bodies and is that also okay? Like more of a neutral... Like you kind of mentioned, I wake up and I'm like “huh, okay,” and I don't necessarily feel one way or another about my body. So not necessarily body positivity but I don't necessarily feel negative about myself.

Paula: Exactly. Roxane Gay whom I love, she had a quote somewhere. And one of the things that she had (amongst other parts of this) but she said that it was “insulting to assume that I am ashamed of myself for being fat, no matter how close to the truth that might be.” And Joy, that's exactly what you're talking about. Can I just be accepting of my body? I don't necessarily have to be positive about it. I just acknowledge that it is, it allows me to do what I need to do, but also knowing that there might be different days that I feel a little bit differently about it. Versus is someone trying to make me accept my size, my shape, my weight?

Dr. Joy: I hadn't heard that quote, I thank you for sharing that. But it really speaks to a sense of entitlement, that like other people get to tell you how you need to feel about your body.

Paula: I’d start at the beginning of it, it says: “It's hard for thin people to know how to talk to fat people about their bodies, whether their opinions are solicited or not.” And she says: “I get that, but it’s insulting to pretend I am not fat or to deny my body and its reality. It’s insulting to think I am somehow unaware of my physical appearance. And it’s insulting to assume that I am ashamed of myself for being fat, no matter how close to the truth that might be.” And whenever I think about body positivity, this is what I think about.

Dr. Joy: So how would you like to see that move forward, whether it be body positivity or something else?

Paula: That's a great question. I think about self-acceptance, how individuals learn to exist in their bodies, learn to exist in society. That might feel a little too idealistic but you think about social acceptance and not allowing society to determine my value. And when I say society, it even could be family. It could be peers but also, like you said earlier, the messages in social media and media and all of these factors that can definitely influence how I think about myself or how an individual thinks about themselves. You’ve given me something to think about!

Dr. Joy: Something for all of us, I think, to think about.

Paula: Absolutely. Because you know, like what is the standard of beauty? I think that's what it is. What’s okay? Interestingly, I think about maybe being connected to your own body when I think about sort of body image distortion and just body image in general, how individuals are sort of disconnected from their bodies. Whether emotionally, the experiences that they have and in an effort to protect themselves. And so if there's a way that we can sort of be more connected, be more accepting–not just of the physical appearance but the emotional stuff, the internal stuff that we are experiencing. I think about that as being probably some really good body image stuff too.

Dr. Joy: Mm hmm. Do you have some favorite exercises or things that you suggest for people who do need to work on being more connected to their bodies?

Paula: Yeah. In some ways, we teach our clients a lot about reappraisals and that's one of the things that I would say is really pretty powerful. Because I think our automatic thoughts, when they occur, it's like the truth, the whole truth, and nothing but the truth, right? Like there's nothing that anyone else could say to me that would make this different or to make me believe something differently. Especially for individuals who are really struggling with eating disorder, disordered eating and even just those who experience body image concerns.

And so when I think about a reappraisal, the intent is to explore–could something else be true? It doesn't mean that it is true because maybe what you believe is your automatic thought may absolutely be true. But reappraisal starts to think about could something else be true? And that's one of the things we encourage and work on with clients. So then maybe my emotional response may not be as strong, I may not engage in some sort of disordered behavior. Instead of if something else could be true, how does that maybe lessen the intensity of what I feel? How could that encourage or change the behavior that I'm using or engaging in to sort of dampen down that emotional experience that's related to some of the distortions I experience in my body?

Also, I think being able to explore what are some of those core beliefs that you have? Going back, if body image is about not just how I believe other people see me but also how I see myself and those internal factors. In addition to the memories and the assumptions and generalizations that occur, then how can I started to explore my core beliefs? And that could be core beliefs about your body, that could be core beliefs about your interactions with other people. And as individuals start to be able to identify what some of those core beliefs may be... And those can be things about I'm unlovable, I'm not good enough, I'll never measure up. Then being able to start to work through that. Like where did this belief form? How does it get reinforced? And then thinking about then maybe some of the things that we engage in, body image wise, could also absolutely be encouraging the core belief.

Dr. Joy: Thank you for that, Paula. Those sound like some great things to kind of keep in mind. Related to both body image but also related to other things. Especially the reappraisal–like could something else be true–I think is a really powerful question.

Paula: And I think like it is so... Again, we even refer to the core beliefs as appraisals and I always think about real estate because it is. What is the value that we're placing on this thought? And that's what we do with our core beliefs. And even some of our general automatic thoughts that we have, that it must be true. Versus a reappraisal, you know, let me go look elsewhere. Let me see if there's something else that may give me a different response in terms of the value. But if we're putting our value external of us, especially if we're trying to fit into the society's standard of beauty, then I think we'll always miss the mark.

Dr. Joy: That point, in addition to the conversation that we had earlier around like plastic surgery, is making me wonder if you have seen anything or even in your own experiences, related to just how accessible plastic surgery and plastic surgeons have become. Like even on Instagram, like I think about Dr. Miami and some of the other people who have really huge platforms. And I feel like years ago, plastic surgery was something very far off. You didn’t hear a lot of people talk about it and if they did, it was very hush. But now like they are doing surgery on Instagram! And so I wonder if that has kind of given people or has contributed in some ways to this body image conversation. Just the fact that it feels so much more accessible.

Paula: Absolutely. Especially if there's people that whether I look up to them or maybe I like the outcome of what they look like, then absolutely. I think then how if I may already be struggling or if an individual may already be struggling, and maybe they just want something to be enhanced or something to be a little bit different... When you're seeing it happen and it's accessible and even the cost is reasonable and payment plans and things like that, then absolutely, I think that has helped increase the frequency of occurrence in the black community.

Dr. Joy: Where can we find good information about things like nutrition? Because I know when I was in school like we had the whole food pyramid and now I think we’ve moved to the plate, and I'm not even sure what they're teaching kids at this point. Where can we find good information about like what we should be eating, what we need to be fueling our bodies? Any resources that you would suggest?

Paula: They can always go to The Renfrew Center's website and we have information about nutrition. I would also say the National Eating Disorders Association. Also, I think maybe having an honest conversation with your providers. And, you know, I don't want to be on a diet, I do want to have normalized eating, I want to be able to incorporate cultural foods and things that I have every day, so what could that look like?

I would also say that if you were to decide to work with a dietitian or nutritionist, make sure there's someone that isn't just sort of diet-focused and they are about health and wellbeing. Because I think that's where you may miss the opportunity to have someone that's going to say, “oh, you need to remove carbs or you need to remove white refined sugar,” you know, whatever it may be, based on the most recent thing that’s sort of bad for you. But staying your ground, I think in many ways, is what I would say because you want to be able to adopt and include any sort of cultural foods. And just acknowledging that your body is different from someone else's body and normalized eating is the way to go.

Dr. Joy: Where can people get in touch with you, Paula? Your website as well as any social media handles you'd like to share?

Paula: Interestingly, and I thought about this when you interviewed Dr. Brooks... I don't do social media either. It is so not a Renfrew thing! I don't know. And I talk to so many different people and they're like, you have to do it. Even someone said that I would *[inaudible 0:42:26] I know that with Therapy for Black Girls who they're black providers, but just acknowledging. Someone said to me like you're a unicorn, you're a black woman that also... First, you’re a black woman therapist and you're a black woman that's treating eating disorders and people need to know that and so on. And I keep sort of thinking like, okay, I'm gonna do this at some point.

But I would say The Renfrew Center is always a great way to connect with me and people will direct you that way. If I can say, I'm also on Therapy for Black Girls as well and so that's a way to connect with me. And even if it's to answer questions, I absolutely have no reservations in doing that. I want to be able to support people and giving them what they need.

Dr. Joy: Perfect. Well, thank you so much for that. It's so funny, Dr. Brooks’s daughter actually listens to the podcast and so she was trying to encourage her mom to get on Instagram after the episode posted so I thought that was really hilarious.

Paula: Yeah. I secretly utilize one of my cousins and so I'll sort of stalk her or, you know, access her social media. I'll say can you post something for me? Typically, I use my family for that but it'll happen soon.

Dr. Joy: Eventually, eventually. Well, thank you so much, Paula. I appreciate you sharing all this information with us today.

Paula: Thank you. Thank you, it was my pleasure and so appreciated. Thank you so much.

Dr. Joy: I'm so glad Paula was able to share her expertise with us today. To learn more about The Renfrew Centers or to check out the resources that she shared, be sure to visit the show notes at And don't forget to text two of your girls and tell them to check out the episode as well. If you're looking for a therapist in your area, be sure to check out our therapist directory at

And if you want to continue digging into this topic or just be in community with other sisters, come on over and join us in the Sister Circle. It's our cozy corner of the internet designed just for black women. You can join us at Thank y’all so much for joining me again this week. I look forward to continuing this conversation with you all real soon. Take good care.


Discover the transformative power of healing in community in Dr. Joy Harden Bradford’s debut book, Sisterhood Heals. Order your copy now!

Sisterhood heals
Order Now

Looking for the UK Edition?
Order here

Discover the transformative power of healing in community in Dr. Joy Harden Bradford’s debut book, Sisterhood Heals. Order your copy now!

Looking for the UK Edition? Order here