By the time Christina Miranda was 12 years old, she was suffering from a severe eating disorder.
After being picked on for her weight for years, Miranda remembers having to design a diet in her middle school health class—her first introduction to food restriction. Soon, she began to withdraw from friends, and stopped going to sleepovers and parties because she didn’t know what food would be there. She engaged in obsessive exercise, closely monitoring and limiting the food she ate.
At her yearly physical, Miranda’s mother was concerned. “This isn’t my child,” she told the doctor. But while Miranda exhibited all the textbook behaviors of an eating disorder, the doctor chalked it up to being “just a phase.”
“I fit the stereotypical, traditional image of what our society thinks an eating disorder looks like,” she says. “I was a very thin, young, white woman. But my doctor still missed it, and signed off on all my forms for school and sports.”
“I think about how hard it was for me to receive treatment, knowing it’s exponentially more difficult for people who don’t fit the stereotype. But I’m going into that field, and I have to do better. I realized that if I want to see a change, I have to create it,” says Miranda.
Two months later, Miranda’s school nurse noticed her low heart rate, and called an ambulance. Miranda was finally put in treatment—which ultimately saved her life.
Now, at age 22, she is determined to prevent this situation from happening to others.
“If it wasn’t for that nurse, I could have died,” she says. “And I was mad about it for so long. I think about how hard it was for me to receive treatment, knowing it’s exponentially more difficult for people who don’t fit the stereotype. But I’m going into that field, and I have to do better. I realized that if I want to see a change, I have to create it.”
That’s why Miranda, along with her best friend Amanda Moreno, co-founded The Body Empowerment Project, which uses preventative interventions to help students make peace with their bodies. Their primary project, Be Body Positive Philly, addresses eating disorder risk in Philadelphia high schoolers by using a body positivity curriculum and near-peer mentorship.
Their project was one of three that won $100,000 through Penn’s President’s Engagement Prize, given to University of Pennsylvania students to create and implement a post-graduation project that makes a positive, lasting impact. The award they earned could not be more timely: Covid-19 continues to exacerbate rates of mental illness among adolescents, including eating disorders, which have the second-highest mortality rate of any mental illness in the U.S.
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While Miranda and Moreno’s dedication to the cause is personal, it is also political. Adolescents are especially vulnerable to develop eating disorders, and the risk is far higher for those in marginalized, low-income populations. According to the National Eating Disorder Association,”Black teenagers are 50 percent more likely than white teenagers to exhibit bulimic behavior, and all minority groups show a higher prevalence of binge-eating disorders.” Until now, there were no interventions to address body image concerns or disordered eating in Philadelphia schools.
Defining health for themselves
As a first generation immigrant from Cuba, Moreno embraces the chance to share her perspective with students in BBPP workshops. “At one school, all the student participants were Hispanic,” she says. “And I deeply related to them. The messages they were getting reminded me of the ones I received as a kid.”
Initially, Moreno began doing eating disorder prevention work in college to support Miranda, but being a facilitator has allowed her to explore her own connection to the topic. Growing up, she found that “people’s bodies and weights were always an open discussion with family and friends.” She was constantly told she was too thin, and needed to change her body. “It did affect my self esteem. As the immigrant girl, I already stuck out,” she says. “I had an accent. I had trouble fitting into the culture. So when people would talk about my body, that added to my insecurities.”
Participating in this program in high school, she says, would have changed her life.
BBPP utilizes The Body Positive’s research-based curriculum, which emphasizes five core competencies that students can practice on a daily basis “to live peacefully and healthfully in our bodies.” Students are taught to Reclaim Health; Practice Intuitive Self-Care; Cultivate Self-Love; Declare Your Own Authentic Beauty; and Build Community. “These are basic skills that students need, and don’t learn otherwise,” Moreno says. “This program is for anyone, and everyone will benefit one way or another.”
This year, she and Miranda conducted pilot programs at Kensington Health Sciences Academy and Paul Robeson High School. Students participated in 10 consecutive weeks of hour-long workshops, which focused on a weight-neutral approach to self-care. These workshops were composed of intimate groups, with 12 students and two Be Body Positive certified undergraduate facilitators. For Miranda and Moreno, it is essential to find diverse facilitators that mirror the multiplicity of student identities they work with.
The sessions are health-centered, but not in the way you might think. Part of the BBPP program is to redefine what it means to be healthy. While our society—with it’s looming $72 billion diet and weight loss industry—often equates health with thinness, Moreno and Miranda assert that this messaging is not only damaging, but wrong. For Miranda, health is much more multifaceted.
“I define health as living a life that’s true to myself, and listening to the needs of my body and mind,” she says. “Mental health is just as important as physical health.”
After learning from BBPP workshops, the students had a chance to define health for themselves. “We gave the students space to explore their definition of health,” Moreno says. “We didn’t impose a definition on them. We sit there with a blank screen on zoom, and ask them what is our collective definition of health?” The students incorporated mental health, loving and respecting themselves, listening to their bodies and even tuning into their souls.
“You can’t look at someone and simply know if they’re healthy—their body size doesn’t tell you anything about them,” Miranda says.
In a workshop on Zoom, the facilitators worked with students to develop their own personal and collective definitions of health. After this session, one student wrote: “I realized that taking care of not only your body, but also your mind and soul, is so important.”
BBPP utilizes a Health At Every Size approach, which emphasizes well-being and behaviors, instead of weight. “You can’t look at someone and simply know if they’re healthy—their body size doesn’t tell you anything about them,” Miranda says.
They also have a workshop that busts harmful body-related myths such as the BMI scale. They break down the fraught history of BMI, and identify the danger of using a weight-centered model of health, which reinforces the idea that there is some correct weight that everyone should aspire to.
BBPP further illustrates that diets are unsustainable and likely to cause mental and physical health problems in the long-term. The program introduces intuitive eating and joyful movement as sustainable alternatives. These approaches encourage tuning in to the body’s innate signals of fullness and hunger, and engaging in movement that feels enjoyable instead of punishing.
Both founders agreed that impacting one student would have made the project worthwhile, but the results were much bigger: 92 percent of students saw a significant improvement in their self-esteem and body image by the midpoint of their program. Principals and teachers noticed a marked improvement in students’ empathy, self-worth, and interactions with instructors and peers in and outside of the classroom.
Expanding to meet community needs
Both founders have just applied to medical school, and are intent on tackling weight stigma and discrimination in healthcare, including the fatphobia that prevents people in larger bodies from recieving adequate care and eating disorder treatment. “There needs to be better training for physicians in this field,” Moreno says.
In the meantime, the partners are developing body image and eating disorder prevention training for 300 school nurses in Philadelphia. “These are the people who interface with students the most, and they are the healthcare providers that know them best,” Miranda says.
“Black teenagers are 50 percent more likely than white teenagers to exhibit bulimic behavior, and all minority groups show a higher prevalence of binge-eating disorders.”
Training school nurses is just one of The Body Empowerment Project’s aspirations—the organization is quickly expanding to meet community needs. Currently, it is composed of Be Body Positive Philly, Be Body Positive UPenn (workshops offered to undergraduates), and their upcoming training program for school staff and educators. In the future, they plan to include corporate training, and bringing their programs to middle schools, elementary schools, and private schools.
The road to creating BBPP was bumpy. The founders faced rejection from grant committees that misunderstood their project, and asked how much weight students would lose. School administrators failed to see the importance of their work, and even national organizations declined to work with them because they felt it was too hard to implement this program in public schools. Even in the eating disorder field, they faced significant backlash: organizations were skeptical of putting effort into preventative work, and lacked the accessible and inclusive resources that the founders hoped to find.
But every time someone misunderstood The Body Empowerment Project, the women took this as evidence of how much the project is needed.
“As two young girls, people underestimate us and don’t take us seriously. We’re used to people underestimating the importance of this project,” Miranda says. But they are certain they can overcome whatever challenges arise. “The pilot results gave us the evidence,” Moreno adds. “We’ve done it. It worked. It’s needed. And we will continue to do it.”
A student participant captured their spirit best: “BBPP is about loving every part of yourself. And when you do, you’ll be unstoppable.”
The Citizen is one of 20 news organizations producing Broke in Philly, a collaborative reporting project on solutions to poverty and the city’s push towards economic mobility. Follow the project @BrokeInPhilly.Header Photo: Christina Miranda (L) and Amanda Moreno, founders of the Body Empowerment Project