šOur Menopause Venn Diagram: Weight-Inclusive Care, Neurodivergence, and Body Image
How can we look at menopause differently?
In the first episode, we focus on the foundations and intersections of weight-inclusive care, a neurodivergent-affirming approach, and body image.
Weāll explore:
What is weight-inclusive care?
How does a neurodivergent-affirming approach relate to menopause?
What exactly is body image?
Why is it so super important to consider in menopause?
How these theories overlap
The menopause experience can be a massive shift in physical and emotional changes and potential challenges.
How can we take more care of our approach?
Episode Resources:Weight-Inclusive Care
Jen Salib Huber RD, ND, The Midlife Feast Podcast - https://www.menopausenutritionist.ca/podcast
Val Schonberg, RD, MSCP - https://valschonberg.com/blog/
Association for Size Diversity and Health, Health at Every Sizeā¢ (HAES) - https://asdah.org/haes/
Dr. Sabrina Strings - https://www.sabrinastrings.com/books
Ragen Chastain - https://weightandhealthcare.substack.com/
A Neurodivergent-Affirming Approach
Judy Singer - https://www.psychologytoday.com/us/blog/inspectrum/202306/an-interview-with-neurodiversity-originator-judy-singer
Kassiane Asasumasu - https://en.wikipedia.org/wiki/Kassiane_Asasumasu
Dr. Nick Walker - https://neuroqueer.com/neurodiversity-terms-and-definitions/
Sonny Jane Wise - https://www.instagram.com/p/Co29RLrhgWT/?utm_source=ig_web_copy_link&igsh=MzRlODBiNWFlZA==
Body Image
Dr. Thomas Cash, Cognitive-Behavioral Model of Body Image - https://www.guilford.com/excerpts/cash2.pdf?t=1
Tylka & Wood-Barcalow, What is and what is not positive body image? Conceptual Foundations and Construct Definition -
https://www.sciencedirect.com/science/article/abs/pii/S1740144515000388?via%3Dihub
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Melinda Staehling
[00:00:00] Hello and welcome. Welcome to the very first episode of Departure Menopause. I'm your host, Melinda Staehling. On this podcast, we're diving into the menopause transition, sharing education and approaches and conversations around health and body image change, all from a neurodivergent affirming and weight inclusive approach.
Right from the start, if you experience menopause, however that looks, I want you to know that if you want to be here, you belong here. I want the space to be warm and welcoming, and I'm so glad you're here. I am excited to get into it, but first, if you wanna get started to depart into what might be the beginning of taking this work deeper you can head to the show notes and download the Regular Eating Guide.
This mini-training includes questions and reflections for you to step out of your everyday and dig into why eating might be inconsistent or even difficult in menopause alongside neurodivergence and what might feel like a challenging relationship with food.
There's a framework to gently walk you through developing your own personalized structure for snacks and meals throughout the day. You can grab the guide for free at the link in the show notes or head to departure menopause club slash regular dash eating dash guide.
If we haven't met yet. Hello, Hi, I am Melinda.
Iām a menopause educator and coach and a certified nutrition specialist with a Master's in nutrition.
On this podcast today, and really overall, we're talking about the intersection of what might be viewed as three separate standalone topics of weight, inclusive care, a neurodivergent affirming approach and body image. Today we're going to examine what these topics have in common with each other and with menopause.
With that, on today's show and on most shows going forward, we do talk about eating disorders and disordered eating and anti-fat and stigma against larger-bodied people. My interest in menopause developed only when I started going through it myself for my entire nutrition Master's program. I swore that I never wanted anything to do with hormones.
It was just not my area of interest. And what I saw reflected back to me in the general population and maybe from a social media perspective, felt a little cringey, even though I went through a long list of prerequisites and coursework in that master's program, the menopause transition was never represented as more than a blip.
[00:03:00] When we think about menopause as a universal experience happening to half the humans on the planet. This is still a shock to me.
Then, my own perimenopause symptoms hit hard in the winter of 2022. I really fell off the cliff and it wasn't easy. I mean, it was really challenging to find the information I wanted without the sight of diet, culture, and wellness bullshit for both myself and also thinking and considering the populations that I serve.
When I say menopause wellness and diet culture, I think you might know what I'm talking about. It's all over from unproven and untested supplements on social media reels, the onslaught of hormone testing kits to the way GLP ones are presented to be the cure for everything now, or how there's a perfect menopause diet plan out there.
Itās how we talk about our bodies in menopause, like āmenobellyā, which I'm putting in air quotes. It can all feel really targeting even for me, and I think about this stuff critically all the time.
I know when I'm low on sleep or sweating the bed or the driving anxiety hits, despite my better judgment, I can start thinking, do I really need that new supplement? Or maybe my fourth sleep mask? Maybe a sleep mask is a bad example because we all need all of those. If you're also caught in a perimenopause hellscape during these already rage-inducing times or have ongoing hot flashes or body changes in menopause, it's hard to know whatās what.
I work with people with eating disorders and disordered eating, people that have quite possibly been chronic dieting or held a challenging relationship with food for a lot of their lives. Much of the menopause advice can feel out of place to even dangerous to this group. And the same advice is often presented as fact from both the medical side or by coaches, creators, and the wellness space.
I don't think people realize just how harmful it can be because it's so often seen as the norm go into any menopause, social media space or Facebook group or maybe even your group chat. And it's common to talk about our bodies and menopause like they're the problems to be fixed.
Extra focus on weight and body composition can make these already mysterious changes seem like there's someone's fault. And when I say mysterious, it's because we weren't taught much of anything about menopause.
And even if we look at the research and medical community that a lot of the evidence around what's really going on with both age and menopause during midlife is only beginning to become clear.
So today, I'm setting us up for our ongoing conversation and we're talking about the intersection of three subjects and some of the ideas that I think are important to consider when we're discussing menopause. And those three topics are weight, inclusive care, the neurodivergent affirming model, and body image.
[00:06:00]
I hope you can play along with me and imagine a three circle Venn diagram with weight, inclusivity, neurodivergence, and body image in the outer rings, and then menopause at the center where everything is overlapping. We'll look at some of the overlap and the intersections, keeping menopause in mind.
Let's go into each separately and offer some foundations and resources and set the stage with some definitions, or I suspect our ongoing conversation might feel a little clunky.
So weight, inclusivity, or weight inclusive care, this term may or may not be newish to you. I think it's a word or a phrase that's better suited and perhaps more encompassing than non-diet or anti-diet.
I know when I talk with my friends that aren't working in this space, I get some blank stares when I talk about weight inclusivity. So I thought that this would be a good place to start. I think it's also a good time to talk about privilege and say that I'm arriving to this conversation as white, cis, heterosexual and partnered, and that other privileges I have and have held throughout my life that are relevant here are that I'm straight-sized and food secure.
I think it's always important to check in and recognize privilege, but doing this now in 2025 when more marginalized identities than mine are under attack feels like it's important to name. Okay, so let's get back to weight inclusivity. You've might have heard of non-diet or anti- diet, but I'm using weight inclusive here to talk about offering the same kind of care.
The term evolved around mostly medical care, but I also think we can talk about wellness in general. So part of weight inclusivity means that people are treated with the same care, regardless of their body size. And another side of that is that we understand and acknowledge the impact of weight bias and weight stigma.
This is a model of healthcare that looks at supporting the health of a person and without the focus or medicalizing or pathologizing body weight or implementing weight loss as an intervention.
This model is accepting of the diversity of body sizes and shapes in the population. The model also acknowledges that there are many factors that go into health, from social to political. I think access to food and clean water would be good examples here.
So with offering the same type of medical care, this means in a real world example that when a larger body person goes to the doctor for their knee pain, they get seen for knee pain and not looked at because they're larger bodied and then told to go home and go on a diet. In a medical setting. This could also mean that in the doctor's office we can be respectful and not hostile when someone doesn't want to be weighed, or even better not weighing at all when weight doesn't actually have relevance to the issue the patient comes in for, which is most of the time if the patient needs to take blood pressure, the office has a blood pressure cuff that's sized to fit and be accurate.
There's comfortable seating in the waiting room, so offering weight [00:09:00] inclusive care might start there. At the very least. For now, I'll let you imagine how this might translate to health coaching or the wellness space or movement in a gym.
This idea of weight inclusivity also encompasses the concepts of weight bias and weight stigma. This gets a little tricky because a lot of the times I hear these two terms used interchangeably. This is sort of my working way of thinking about weight bias and weight stigma like this.
If being objective about something is lacking bias or thinking about both sides of the issues, or coming from a place of seeking truth, then weight bias might be lacking any objectivity and tending towards the very negative thoughts and opinions around higher weight. Then weight stigma shows up as more of the negative attitudes, the social disapproval and discrimination towards higher weight people.
These are terms describing the privilege that one person might receive because of body shape over another, and I can bet you think of how this might be related to menopause. Who gets better care when they go to the doctor's office for their hormone therapy appointment and gets to spend their time talking about their current menopausal symptoms instead of discussing a diet plan.
Weight stigma has real effects and consequences. Many larger bodied people have a lifelong avoidance with absolutely no blame here on their part of medical care because of the stigma against their bodies, or higher rates of depression and anxiety due to societal prejudice. When you reach midlife and you really need some care for these changes, well then it's extra hard to go to that appointment.
And I do wanna say that while this affects people at the highest end of the weight spectrum, the most anti-fat and weight bias and weight stigma affect everyone. I know a lot of people in every body size whose days are destroyed when they're asked to get on the scale in the doctor's office because we've wrapped so much meaning into weight.
There are people of all body sizes who move through life restricting food daily. That can happen in any size body, and that's the impact of weight stigma.
One pause to say that the ideas I'm discussing here are not mine and they're not new. Tracy Tylka and author's paper on Weight-inclusive Compared to Weight-Normative Approaches came out in 2014, so we're talking about a decade or more where I think this phrasing has been out and discussed in the research and now is in practice.
And that paper was built on its own set of previous research. When it comes to weight-inclusive menopause, I don't see that being discussed as much. Jen Salib Huber has a current podcast, the Midlife Feast that discusses menopause from a weight-inclusive and more of an intuitive eating approach.
Val Schoenberg, who is also a dietician and menopause society certified practitioner, talks about this too in her work. But if we go back, historically, the size inclusive and Bipoc communities have been around for a long time talking about the need for this kind of care because there's a link and an intersection between race and size and health.
[00:12:00]
This includes HAESā¢ or the Health at Every Sizeā¢ community, which is trademarked and their work through the Association of Size Diversity and Health, and researchers and authors who have been working in the size-inclusive or weight-inclusive space for decades.
Dr. Sabrina Stringsā book, fearing the Black Body, the Rachel Origins of Fatphobia came out in 2019 and fast forward to present day. I'd say Ragen Chastain puts out a monumental amount of content to summarize weight-inclusive research and challenge anti-fat. So those might be some connections to make if you're wanting to dig into the context of weight, inclusivity.
I think it's important here to ground into the knowledge that this is a framework with research and history standing behind it.
Okay, so let's take a turn. And the second topic on our list today is neurodivergence. And what I really mean is a neurodivergent affirming perspective. A few definitions to start, so maybe if you're new to this term, neurodiversity, Judy Singer is known for creating the term in the nineties to speak about how all brains can function differently.
Neurodiversity is a plural for all of the different neuro types out there. Neurotypical and neurodivergent Singer later came to expand with Neurodivergence, and that term is for brains that are functioning outside the usual or the norm of what's neurotypical Kassiane Asasumasu is also credited for that word, neurodivergence and other terms in the neurodiversity movement.
Like we talked about with weight inclusivity, the neurodiversity affirming model comes from a long history of people working in intersecting spaces of social justice, racial justice, and disability justice. I want to highlight Dr. Nick Walker's essay Neurodiversity: Some Basic Terms and Fefinitions, which was written in 2014. And if you're new to the vocab here, that is a great place to start.
I also think that sometimes we might limit our conversation about neurodivergence to ADHD and autism, but there are a lot of neurodivergent identities.
I want to call myself out here because at least on these first few episodes, I'm doing a solo podcast about neurodivergence, and this should really be a conversation and not a monologue.
So the goal is to invite a lot of conversations, and I'm arriving here today with curiosity and interest and the willingness to get some of this wrong.
Iām going to link to Sonny Jane Wise's most awesome graphic of the Neurodivergent umbrella, which is a literal umbrella and has a whole smattering of possibilities for neurodivergent identities in the show notes.
I know I'm always attempting to expand my thinking around what is Neurodivergence. So with more advocacy, and I'll include social media in this, there's been a rise in interest in neurodivergence. With that, there's also a rise in late diagnosis, especially around the menopause transition.
[00:15:00] While I think we're at this cultural moment of understanding about this link to menopause and neurodivergence, both from people that we're early identified or just now coming to this understanding, we don't have much of a research base to turn to.
What we do have are folks who can I hypothesize because of their unique lived experience or training and interest and perspective of why menopause and neurodivergence might be intersecting in this way at this time. So if you identify as neurodivergent and are menopausal, then you might already know what I'm talking about from your experience.
The hormonal rollercoaster of perimenopause, which is mainly estrogen-driven, but also plays into shifts in other hormones, creates an environment where neurodivergence for many of us, becomes amplified and even unmanageable to the point where we might need to develop new strategies or possibly seek a diagnosis for the first time.
While we think about menopause body changes, I think we can also think here about how menopause impacts the brain in a lot of ways. An example would be an increase in low mood or symptoms of menopausal anxiety and depression.
Going with brain changes, there can be a shift in memory processing and menopausal brain fog. A hallmark of neurodivergent identities is challenges with sleep, and the shifting hormones at perimenopause can make sleep feel impossible. So there's another intersection
with a neurodivergent affirming approach, we're accepting that neurodivergence is something that's usual and expected in the population, and while it can be challenging to live in a world that's not designed for you, there's also a realness to that which can be disabling. I think menopause can learn a lot from neurodivergent affirming and weight-inclusive care perspectives. The pathology model of neurodivergence and weight is set out to fix. I think of how from my world, the more pathologizing, nutrition, and functional medicine practitioners are always out to throw a new supplement or elimination diet at autism or ADHD.
With the medical model of both menopause and neurodivergence, we're treating symptoms and we're out to fix something with a more affirming model. We're looking at how we might reduce the distress and challenges so the person has improved function. We're not. We're not out to fix Neurodivergence. We're out to heal the system that leads to masking and lack of accommodations.
When I think about menopause, couldn't we learn a lot from that model? From how we treat our bodies to menopause and workplace culture, to how we view getting older.
So we looked at weight, inclusive care, and a neurodivergent affirming approach. And now I want to bring the third circle in our Venn diagram of body image into the mix.
Body image is a term that describes the thoughts, feelings, and emotions that we have about our body. This way of thinking about body image is coming from a cognitive behavioral model of body image.
[00:18:00] And of course there's a lot of different ways and frameworks to think about body image. A lot of the times when we're discussing body image, it's either that it's good or it's bad, like it's on a continuum.
You can also think about body image as negative body image and positive body image, like these are two distinct constructs. Like there are two knobs on a stereo that is so analog of me. So a negative body image would lead to more negative thoughts and behaviors like body checking or restrictive dieting and reactions to those thoughts.
And then on the flip side, a positive body image would be to experience, respect and appreciation for your body. And the two might even overlap. Sometimes, like I think in one situation, one might seem a little higher than the other, as an example, you might have a more negative body image about specific body changes that take place during menopause, but you also have more positive body image about your body when it comes to something you're really skilled at.
Like maybe you are the best pool player and you know, you've spent years and decades refining that skill so you can appreciate your body and what it does. Or you have some incredible tattoos that are very meaningful to you and you have that connection with your history and your body, and at the same time, there's negative body thoughts and behaviors there as well.
Body image can shift during different life stages or transitions.
I think of how for many of my clients getting into the warmer months and the ideas of wearing summer clothing can be a move towards more negative body image, thoughts and behaviors or how the holidays can bring up a lot for people
when we think about it in terms of lifespan, we recognize puberty as a time where negative body image might creep in, and then there's menopause and we go through this big change physically and emotionally and often instead of protecting ourselves against the threats of disordered eating and more negative body image emotions and behaviors. There's this big push to engage in the very behaviors like dieting and macro tracking, or excessive exercise and negative appearance focus that are the very risk factors for more negative body image.
Well, I think there's a lot to talk about with neurodivergence and weight-inclusive care in a menopause. This body image piece is also really important. In one study that took an internet survey of 1800 women over age 50, 80% of the women surveyed that weight and shape played a moderate to important role in affecting their self-esteem.
I went to a menopause conference over the weekend, and I looked around in the roo,m thinking about that 80% number in the full conference room.
[00:21:00]
So I'm going to wrap up today with a short list of connections about weight, inclusive care, neurodivergence, and body image. [00:21:00] Here's a shout-out to Naureen Hunani. I took a course from Naureen who runs RDs for Neurodiversity.
She's a multiply neurodivergent registered dietician who writes and teaches extensively about neurodivergence and eating disorders. The course was neurodiversity and weight-inclusive care.
So I'm going to finish today with four ideas about the intersection of weight-inclusive care, a neurodivergent affirming approach, and body image, and we can think about how these ideas might connect to menopause.
Number one, neurodivergent people tend to have a more complicated relationship with food, higher rates of disordered eating and eating disorders.
Then we layer in stigmatizing medical care and wellness that's extra focused on weight. I think you might be able to see how this can connect with the big wellness, massive menopause, and possibly instead, how we might take a more compassionate and measured approach without the focus on weight.
Number two, when we prioritize and emphasize weight over health, we steer people, especially people that are already vulnerable, either because of weight bias and stigma or neurodivergent bias.
We lead people towards a more negative and less positive body image. Menopause is a time where we need more and better access to healthcare and not less because of avoidance, stemming from fear of judgment. I also wanna say this with as much grace as possible, and I know that most of the world sees this as a problem to be fixed, but in menopause and midlife, body and weight changes are common and usual and expected.
Number three. Neurodivergent people have higher rates of mental health challenges. The menopause transition and especially perimenopause, also leads to a spike in symptoms of menopausal depression, anxiety, and disordered eating and eating disorders. So here we have this compounding effect of vulnerability within the menopausal timeline.
And finally, neurodivergent people present with high levels of perfectionism and issues with self-esteem. They're already driven to masking and performing neuron normative behavior. And this tendency towards masking and overachievedness can lead to more negative body image and sense of self.
So that's some of my big-picture thoughts around the connections between weight-inclusive care, neurodivergent affirming approaches, and body image and menopause. By exploring these topics and by going through the ideas, you can see how menopause experience is important to consider as a huge shift in physical and mental and emotional changes and potential challenges, and how we might take more care with our approach.
[00:24:00]
I hope you came away with some new thoughts sparked by the connections. Thanks for listening and coming on this journey with me to depart from the usual in menopause. Special thanks on this launch episode to Amelia Hruby for her advice and podcast course, Your Podcast is a Portal. Podcast art is by Barb Burwell.