weight stigma

What Is Diet Culture?

If you're familiar with my work, then you know I'm all about dismantling diet culture. But what exactly is diet culture? It's a term that gets thrown around in anti-diet spaces without a lot of unpacking, but it's incredibly important to understand so that we can recognize how it's showing up in our lives and fight back. Here's how I define it:


My Definition of Diet Culture

Diet culture is a system of beliefs that:

  • Worships thinness and equates it to health and moral virtue, which means you can spend your whole life thinking you’re irreparably broken just because you don’t look like the impossibly thin “ideal.”

  • Promotes weight loss as a means of attaining higher status, which means you feel compelled to spend a massive amount of time, energy, and money trying to shrink your body, even though the research is very clear that almost no one can sustain intentional weight loss for more than a few years.

  • Demonizes certain ways of eating while elevating others, which means you’re forced to be hyper-vigilant about your eating, ashamed of making certain food choices, and distracted from your pleasure, your purpose, and your power.

  • Oppresses people who don't match up with its supposed picture of “health,” which disproportionately harms women, femmes, trans folks, people in larger bodies, people of color, and people with disabilities, damaging both their mental and physical health.


Diet culture doesn't just mean “being on a diet,” because you don't have to follow any sort of official diet to be caught up in the culture of dieting.

Moreover, some people may eat in a way that they refer to as a diet for legit medical reasons (e.g. diagnosed celiac disease, diabetes, etc.) and not actually be engaging in diet culture (which, I should add, is very rare and hard to do, since diet culture has its tentacles all up in the medical field).  

I've worked with hundreds of people who think they're not dieting, but when we dig into their relationship with food, they realize that they're pursuing “wellness” or “health” in a way that looks veeeeeery much like a diet. 

That's a form of diet culture that I call The Wellness Diet, and it's rampant in the 21st century. “Clean eating,” detoxes, cleanses, the overuse of elimination diets, carb restriction, gluten phobia, “ancestral” diets, and performative health all fall under the umbrella of The Wellness Diet. The weight-stigma aspect of diet culture may be de-emphasized in some iterations of The Wellness Diet, but the moralization and demonization of food is front and center.  

There are many other forms of diet culture, too. It's a sneaky, shape-shifting thing that robs people of their time, money, health, happiness, and so much more, which is why I've nicknamed it The Life Thief. It can be hard to spot, and yet in Western culture, it's everywhere. 

To learn more about diet culture, how to recognize it, and how you can reclaim your life from it, check out some of my writing on the subject, and tune in to my podcast, Food Psych. I'm also working on a book about diet culture that's coming out in January 2020, so be sure to check back here for more info, or pop your email address in the form below to stay in the loop.

Diet culture is a form of oppression, and dismantling it is essential for creating a world that's just and peaceful for people in ALL bodies.

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How to Avoid Falling for The Wellness Diet

At this point in history, many of us have gotten wise to the more overt manifestations of diet culture, and we’re not buying them.

Commercial weight-loss programs, “lite” foods, diet books: We’re over it.

We know that diets don’t work—and the diet industry knows we know.

“Many millennials today view Weight Watchers and Jenny Craig as your mother’s (or grandmother’s) weight loss program,” reads a 2017 market analysis by Marketdata LLC, an independent market research publisher that also offers consulting and strategic planning to the diet industry. “This will be the challenge—to stay relevant and cultivate this future generation of dieters.”

Let that sink in for a sec: Stay relevant and cultivate this future generation of dieters.

That’s exactly what diet culture is out to do these days, because it stands to lose a LOT of money if it doesn’t.

“Millennials are the future dieters,” says the Marketdata report. “Any weight loss company that continues to focus most of their efforts on Baby Boomers is sure to wither and die.”

In an attempt to stay relevant, young, and hip (with all the ageism inherent in that effort), diet culture has had to morph and shape-shift.

 

The Wellness Diet

Amid all these changes in the diet industry, diet culture has figured out a way to reinvent itself: as The Wellness Diet.

The Wellness Diet is my term for the sneaky, modern guise of diet culture that’s supposedly about “wellness” but is actually about performing a rarefied, perfectionistic, discriminatory idea of what health is supposed to look like.

It’s not just about weight loss, although thinness is an essential part of The Wellness Diet’s supposed picture of health. (So is whiteness, and youth, and physical ability, and wealth.)

It’s also about eating the “right” things and removing supposedly “impure” foods from your life.

“Clean eating,” detoxes and cleanses, mass hysteria about gluten and grains, and elimination diets prescribed for the general population are all part of The Wellness Diet.

They’re ways of demonizing some foods and styles of eating while elevating others, and they force us to be hyper-vigilant about our eating and ashamed of making certain food choices.

The Wellness Diet is my term for the sneaky, modern guise of diet culture that’s supposedly about ‘wellness’ but is actually about performing a rarefied, perfectionistic, discriminatory idea of what health is supposed to look like.
— Christy Harrison, MPH, RD, CDN

Whenever I bring up this connection between wellness culture and diet culture, there are always a few people who protest that what I'm calling The Wellness Diet is really about health, not dieting—and of course I acknowledge that some people with certain health conditions (like folks with celiac disease, for example) might benefit from making a few changes in how they eat.

But that’s not the general population; the vast majority of folks don’t need to cut any foods out of their life, but instead would do better to explore the role that disordered eating might be playing in their health outcomes.

And NO ONE needs a cleanse or food-related “detox” (Content Warning [CW]: restrictive eating practices, health recommendations). Your liver, kidneys, and lungs do a great job of that already, without any intervention from you.

What’s more, the “it’s about health, not dieting!” argument is exactly what diet culture wants you to think.

As Marketdata’s diet-industry report puts it, “‘diet’ has become a four-letter word in the minds of many consumers, as they shun commercial weight loss programs such as Weight Watchers. ‘Healthy’ eating has replaced ‘dieting.’”

Diet culture has co-opted wellness culture and disguised itself as "healthy eating." Hence: The Wellness Diet.

 

Food Isn't Always Medicine 

Of course nutrition can play a role in our overall well-being, but the widespread cultural belief that “food is medicine” is incredibly problematic.

It suggests that consistently making the “right” food choices will heal or prevent all ills, and that eating certain kinds of food will inevitably harm our health.

Scientific research disproves this belief by showing that to be in good physical health, people don’t need to cut out “processed” foods or sugar (CW: nutrition information), and that weight stigma is actually a bigger determinant of health than actual weight OR eating habits(CW: BMI numbers)

You DON’T need to demonize certain food groups, or restrict your overall food intake, or treat food as the be-all-end-all of health.

In fact, putting too much emphasis on our day-to-day food choices doesn’t lead to improved health at all, but to a preoccupation with food and panic about our health.

The Wellness Diet can easily slip into orthorexia, a type of eating disorder characterized by an obsession with healthy eating.

So if you’re following The Wellness Diet, then you’re actually putting both your physical and mental health at risk.

Of course food can play a role in our overall well-being, but the widespread cultural belief that ‘food is medicine’ is incredibly problematic.
— Christy Harrison, MPH, RD, CDN

If you really value and want to pursue health (which no one is morally obligated to do, BTW), then it’s important to understand that food is just a small part of the equation, and that things like mental health, access to compassionate and evidence-based healthcare, and eliminating weight stigma are far more important.

Health has a lot less to do with our individual choices than we’re led to believe in diet culture.

That’s what I discussed in the Q&A portion of this week’s episode of Food Psych.

I got a great question from a listener about how to frame public health efforts in a way that doesn’t stigmatize people in larger bodies, and I talked about the many factors that matter more for our health outcomes than just food and exercise choices.

Tune in to hear this discussion, and also catch my amazing conversation with psychotherapist and author Judith Matz about how physical deprivation—rather than emotions or psychology—is the primary driver for feeling out of control around food.

We also talked about the negative health outcomes related to weight cycling and weight stigma, the health benefits of intuitive eating, and so much more.

Check it out here or wherever you get your podcasts!

Here’s to getting off The Wellness Diet and finding true well-being,

Christy

P.S. If you want support for letting go of The Wellness Diet—or any other form of diet culture—come join my intuitive eating online course and community. You’ll get a wealth of resources for learning to trust yourself with food, so that you can free up time and energy to the things that really matter in life.

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The Truth About That New “Fat But Fit” Study

I got an email this morning from a reporter at The Daily Meal, asking me to give my thoughts on a new study. News outlets are claiming this new research is evidence that "fat but fit is a myth" and "there's no such thing as metabolically healthy obesity." 

I won't link to the study or those articles here because they reinforce weight stigma, which is bad for your health (more on that below). But the study is called "Metabolically Healthy Obese and Incident Cardiovascular Disease Events Among 3.5 Million Men and Women," and it just came out this week in the Journal of the American College of Cardiology (after being widely covered in the media before publication).

The Daily Meal reporter, Holly Van Hare, did a lovely job with the story, so be sure to check it out (trigger warning for this and all the study links below). But of course I have a lot more to say about this issue than could fit there, so here are my unabridged thoughts: 

 

Weight Stigma and Weight Cycling

First of all, the study didn’t control for two likely risk factors for heart disease, independent of body size: weight stigma and weight cycling.

People in larger bodies are more likely to be stigmatized for their size—bullied and shamed in school, at home, walking down the street, and in the doctor’s office, and paid lower salaries than their thin peers in the working world—and when people internalize weight stigma, it has profoundly negative effects on their mental health.

Experiencing this stigma also raises people’s risk of chronic diseases including heart disease—regardless of actual body size. What's more, weight stigma results in people delaying or avoiding going to the doctor, which can lead to poorer health outcomes down the line. 

People in larger bodies are also more likely to have weight cycled or “yo-yo dieted” in the past, and weight cycling has also been associated with a greater risk of heart disease.

Weight cycling tends to drive people’s weight up over time; up to 2/3 of people who embark on intentional weight loss actually end up heavier than when they started. (For more on these underreported aspects of weight science, see Linda Bacon and Lucy Aphramor’s great paper “Weight Science: Evaluating the Evidence for a Paradigm Shift.”) 

Until weight science can control for weight cycling and weight stigma, we can't say that being at the higher end of the BMI spectrum causes any health conditions—even if higher weights are associated with these health conditions. Correlation does not equal causation, y'all.

Moreover, *even if* weight did have some causal effect on people’s health (which is possible, but again we can’t actually know until we control for weight stigma and weight cycling), we DON’T HAVE a known way for more than a tiny fraction of people to lose weight and keep it off permanently.

The success rate of intentional weight-loss efforts is 5% or less, by most researchers’ accounts. So for 95% or more of people, ALL diets are yo-yo diets.

And we know yo-yo diets negatively affect people’s health outcomes from the research I mentioned above!

So EVEN IF weight itself were partially to blame for the heart disease outcomes, medicine doesn’t actually have a known way for people to lose weight and keep it off. Prescribing weight loss just is NOT ethical healthcare. 

There has to be a better way. 

 

Health at Every Size and Health-Promoting Behaviors

That’s where Health at Every Size® (HAES) comes in. HAES is about engaging in health-promoting behaviors without pursuing weight loss, as well as working to change society to reduce weight stigma and other forms of social injustice that harm people's health. HAES approaches have been shown to have better health outcomes than the traditional weight paradigm. 

That's what I mean by ethical healthcare.

BTW, the new study also doesn’t say what the larger-bodied participants were doing or not doing to support their health during the follow-up period. The researchers only controlled for the potential confounding variables of "age, sex, self-reported smoking status, and social deprivation" (a measure of socioeconomic status, education, and employment).

The researchers didn’t determine whether the study participants were restricting their food intake and experiencing rebound bingeing during the study period, versus eating intuitively.

They didn’t determine whether participants were engaging in (and enjoying) physical activity, versus having lack of access to accommodating and welcoming spaces for movement. 

The researchers also didn’t control for whether the participants had access to compassionate healthcare providers who supported their *actual health* instead of focusing on their weight and reinforcing weight stigma.

And all three of those things can affect people’s health outcomes, again *independently of body size.*

A few other thoughts: study subjects who were in the underweight category with zero metabolic abnormalities also had greater heart-related risks (e.g. elevated risk of heart failure) than the people in the "normal-weight" BMI category. Why don’t those results get reported by the media? Why aren’t newspapers and websites trumpeting “the risks of underweight for cerebrovascular disease"? Weight bias much?!? 

The vast majority of media don’t report the nuances of these scientific studies because most reporters don’t actually know how to parse them—and I was one of them before I got a master’s in public health, so I know how it goes. Many reporters just use the press release or the abstract to report scientific studies, and others might give a cursory glance at the actual study but are just looking for confirmation of what they already believe it says.

I don’t know the exact stats, but I’m willing to bet a very small percentage of reporters who covered this story even SAW the study’s finding that people in the “underweight" category have a higher risk of heart failure than people in the “overweight” category, or that the study didn’t control for nutritional intake, physical activity level, weight stigma, or weight cycling. (I know Van Hare was one of this small percentage who did see the full study, which is awesome.) 

Mainstream health media needs to do better. But that's a story for another time. 

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Last updated April 2, 2019

The Truth about Intentional Weight Loss

As an anti-diet dietitian and certified intuitive eating counselor, I'm committed to helping people make peace with food and their bodies. In my view, the ONLY way for healthcare providers to accomplish that is to practice a philosophy called Health at Every Size® (or HAES), which helps people focus on health-promoting behaviors rather than weight loss. 

The reason HAES takes weight loss out of the health equation is because intentional weight loss is not only unsustainable 95+ percent of the time (and most people actually gain back more weight than they lost), but pursuing weight loss also causes more harm than good to your physical and mental health. 

You've likely experienced this harm firsthand if you've ever done something to try to lose weight (a diet, an eating plan, a "lifestyle change"), because most people who pursue weight loss end up having negative reactions.  

Maybe for you it was following the diet or plan during the day (or during the week), and then eating large quantities of food and feeling out of control at night (or on weekends). 

Or maybe it was obsessively planning meals, tracking and logging everything you ate, and just thinking about food nonstop.

Maybe it was exercising in a compulsive, self-punishing way.   

Or maybe it spiraled into cutting more and more foods out of your diet and being afraid of the foods you used to love.

These are all incredibly common, completely normal reactions to the deprivation that people feel when pursuing weight loss.

And they're also not helping your health.

There is a better way to support both your physical and mental health, and that's where Health at Every Size comes in.

My guest on this week's episode of Food Psych is an expert on HAES, and she's also one of the smartest, most well-spoken people I know.  

Writer, speaker, and health coach Ragen Chastain explains why healthcare providers need to stop prescribing intentional weight loss, how weight stigma (not body size) is likely responsible for the health issues typically associated with higher weights, why weight loss doesn't actually improve physical performance, the true meaning of the word "health," and lots more. 

Tune in to this incredible episode to hear Ragen's wisdom, and join us in the Food Psych listener Facebook group to share your thoughts! 

xo, 
Christy

P.S. If you haven't seen my pal Isabel Foxen Duke's free video training series, Stop Fighting Food, be sure to check it out! I signed on to be an affiliate for Isabel's private coaching program this year because I love her work so much, so if you end up joining that you'll be supporting my work, too. But either way, check out the videos to get some great tips for making peace with food! 

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"Fat But Fit Is a Myth" Is a Myth

For the past few days, the British media has been awash in headlines proclaiming it's a myth that people can be both fat and fit, referencing unpublished research that was presented at a European medical conference.

I'm not going to link to the articles because they're potentially triggering for anyone with eating disorders or internalized weight stigma, but they can easily be found in a Google search (seriously, though, TW if you're trying to recover from society's toxic messages about body size).

Since I'm a dietitian and podcaster specializing in intuitive eating and Health at Every Size, many of my clients and listeners have asked for my opinion on these articles. Here's my take: 

First of all, since the research hasn't been peer-reviewed and published, it's extremely irresponsible for these media outlets to run stories about it. There's always a chance that when peer review and publication are complete, the researchers' conclusions won't look nearly as clear-cut as they're making them out to be.

I also highly doubt the researchers controlled for weight cycling, which is associated with greater disease risk and which we KNOW larger-bodied people are more likely to have gone through.

That's to say nothing of internalized weight stigma--I'm willing to bet the researchers didn't control for that--which again has been associated with higher disease risks. So there could be many reasons for their findings that have nothing to do with the people's actual size, but with how people of size are *treated* in Western society, which we know is badly.

On top of all of that, remember that we still don't have any way for people to lose weight and keep it off in the long term, other than seriously disordered eating--which of course brings more acute and immediate health risks than living in a larger body ever could.

It's also true that many different immutable physical traits carry different risk factors for disease. Your height, your ethnicity, even your eye color are all associated with higher or lower risks of certain diseases. Even if body size really does carry a higher risk of certain diseases, it's not something people can sustainably change about themselves, just like these other immutable factors. We all have different genetic risk for certain diseases, and we all have protective factors as well. Whatever our body size, eye color, ethnicity or height, none of us are immortal. We're all doing the best we can, and one day our bodies are all going to break down. Sorry to get morbid, y'all, but it's true.

We shouldn't be prescribing something to larger-bodied people (weight loss) that we know a) doesn't work and b) actually puts people at higher risk of disease because of weight cycling and internalized stigma. The conclusions of those British media articles are basically "so doctors, tell your fat patients to lose weight," which is exactly what fat people have been being told for DECADES, despite evidence piling up that this advice is not helping anyone's health. 

So in short, these articles are garbage. Don't let them drive you toward dieting and away from sustainable self-care. (For more on the research about weight stigma, see LindaBacon.org or do a Pubmed search for this term.)

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