how to create an “anti-diet” culture and in the meantime, live with diet culture, because we can’t get away from it!
What is diet culture?
Sometimes it seems like everything! Some examples are: all the ads for diet products, the labeling of foods, the way people accept the idea that food is “good” or “bad” or “clean,” our accepted standards of beauty, healthcare stigma, and the consistent misrepresentation of the motivations of people with eating disorders and what an eating disorder really means.
Recently, I had several conversations with family, friends, and clients all touching on various aspects of this. These are just the ones that have come up in my personal conversations and by no means represent the entire problem.
Along those lines, my goal would be for people to start talking about it. We walk around believing all of this and take it for granted so much of the time, it is so ingrained in our collective consciousness, that we honestly don’t know we are doing it. So the more we talk about it, the better off we will all be.
How do you define health?
Not by weight, that’s for sure.
Despite the fact that most of us use that as a measure of health, it really is not a good one at all, and we use it so poorly – hardly ever do we seem to take other factors into consideration. BMI is a joke – it measures nothing more than your weight to height ratio and has no more validity. This article talks more about why BMI is a scam and how it can be a useful statistic for population studies but is useless for individuals.
Doctors are some of the worst perpetrators when it comes to measuring health by weight. To a degree, it is not their fault – they do not have any more education about weight management than your average person, and we tend to treat doctors like they know everything. But you never know what assumptions they are making or what harmful things doctors might say to their patients. As for telling people to ‘lose weight’ as a clinical intervention – it’s really just laziness. Dr. Jennifer Gaudiani and Dr. Joshua Wolrich both have some interesting things to say about that!
I remember going to the doctor’s once and she actually told me she does not eat all day and just had dinner with her family – to manage her weight! I responded to this with “You know where I work, right? At the eating disorder center?” She just looked at me blankly and did not even realize that restricting calorie intake is harmful, that she is setting herself up for health issues, and that she could be setting her client up for an eating disorder. She was actually recommending disordered behavior for weight management – and I have heard much worse stories from clients about the things their doctor says to them. When I tell other eating disorder professionals this story, they are appalled. When I tell other people, they shrug and are not sure why I have a problem. Almost every time, I have to explain why those comments, especially from a health professional, are biased, incorrect, harmful, stigmatizing, and lazy.
We have known for a long time what makes you physically more healthy and what doesn’t – it’s not really that difficult to figure out, or even to implement – the big four predictors of physical health are if you don’t smoke, drink moderately or not at all, eat vegetables, and exercise moderately. You can get more complicated than that, of course, but that all depends on what message you are trying to get out – do not even get me started about how the media use misleading statistics to sensationalize health stories. You can also define physical health in various ways, like longevity, health function, self-perception and chronic illness (to name only a few). I like the 100 ways to live longer, personally, since many of them seemed manageable (like eat more beans, live by the coast, sleep enough) and none were focused on weight as a definition of health.
Weight Bias & Stigma
Did you know that dieting is the single biggest predictor of future weight problems? And that 40% of girls age 4-7 report going on a diet and 80% of ten year olds think they need to diet even at normal weight? Or that the diet industry makes several hundred TRILLION dollars a year making us think we need to diet? This has been going on a long time (here is an article from 1986) and social media has only made it worse. What have we done to change it? Pretty much nothing. The statistics page at NEDA shows it has only gotten worse.
Weight stigma is nothing new.
Harvard IAT has been conducting research on bias for years about several different things, but the weight, gender, and race bias quizzes are the ones that I think are relevant to this discussion. There is a lot of institutionalized racism inherent with weight bias – this has come up more recently in relation to COVID, but it has been a problem for a very long time. Even the language we use around these biases is similar. When I was talking to a friend about the connection between mental health and race, she said she was not aware of the issue of weight bias in healthcare and eating disorder treatment and how it makes it even less likely that people of color will seek treatment even when their behaviors indicate a clinically diagnosable eating disorder.
I have never been, nor will I ever be, a thin woman. I remember in my teens and 20s thinking that I needed to do something about it (not that I really knew what or really ever did anything for any length of time). I heard comments all the time about various aspects of my appearance, including weight, and remember thinking that it was weird that most people commented on body parts (positive, negative, and just confusing comments) and made it seem like my parts were something separate from my self.
When I started working in this field, specifically with eating disorders in 2004, I thought that everyone was going to think less of me and shame me for my weight. No one really noticed, or at least never said anything directly to me about it at work. But I still thought about it. I still bought into some of it. And even now, with so much more awareness, I catch it in my own thoughts. I see it everywhere – eating disorders, weight stigma, mental health stigma, sexism, racism, shaming of all kinds.
My main defense, right now, is critical thinking.
I try to use my common sense, Occam’s razor, and Hanlon’s razor. I try to be aware of my biases. And I have to work at it, every day, not to get caught up in diet culture nonsense. I don’t want anyone to think it is easy, but like all things worth doing, you have to work at it. I hope, someday, that those thoughts and all of the messages that trigger them will disappear. But I think it is much more likely that I will learn to ignore them more and more consistently until I just notice them less.
Eating Disorders
Weight stigma and bias, especially our own, is a driving force behind why people who do not fit the stereotypical anorexic profile do not seek treatment. The majority of people with eating disorders do not fall into this stereotype – white, cisgender, relatively affluent and educated women with insurance and family/social support available to them. Study statistics vary, but recent estimates indicate that only about 20% of people with eating disorder behaviors consistent with a DSMV diagnosis seek any kind of treatment! Most of them (about 70%) do not get specialized treatment at all, and it is not available in a lot of places (ED treatment centers are focused in larger metropolitan areas).
Even when people do get treatment, they come in with all kinds of notions about eating, weight, body image, and mental health that it usually takes months to unpack it all (the average length of total treatment for an eating disorder is 70 months). I enjoy working with clients on that, and hearing their experiences and insights. I like talking about it in general! Not because it is fun, but because I think it is worth it.
What to Do
Challenge it
The number one thing I want people to know is a basic principle of CBT (Cognitive Behavioral Therapy) –
you cannot just ‘stop’ thinking about something – you have to replace it with something that you genuinely believe in order to facilitate change.
This means that we have to replace and challenge all of the diet culture beliefs that we have been taught. We need to talk about it with people we care about, use critical thinking skills, apply our common sense and combat the dozens of messages we get every day from media, social media, well meaning friends and family, doctors who don’t know any better, and all of the messages we send ourselves without realizing it every day.
Talk about it
Most of us do not realize how much, in how many ways, and in so many aspects of our sense of self we support and disseminate diet culture and weight stigma messages. That is why it is so very important to start talking about it, and to be open about it. It is difficult, and it is necessary, if we are ever going to de-stigmatize weight, eating disorders, and mental health.
Stop perpetuating it
I cannot tell you how many times I have told someone I work with clients who have eating disorders and they say something along the lines of “I have the opposite problem [I eat too much]” or “I wish I had a little of that.” I see those comments as being part of this larger problem of stigma and misconceptions in the general public. I have heard all kinds of things from people. An old colleague came up with a good response to the “I have the opposite problem” comment –
“Oh, you have a healthy relationship with food and your body?”
Alexis Hunter, former Director of Professional Relations for the Chrysalis Center
The looks on their faces…
But that is the goal. A healthy relationship. One that is sustainable. That makes you feel good, physically, and does not cause medical issues or social dysfunction.
Have compassion
For yourself and anyone else who might be struggling. It takes some work, but lovingkindness goes a very long way towards making the problem smaller.
‘In Addition to’ Resources:
Note: for simplicity’s sake, if I included the resource in one category, I did not include it in others, despite the fact that the resource may have a podcast, a book, a website, and a social media presence. This is based on my personal experience of these resources and how I became aware of them. I also did not include any resources that I already linked in the body of this article. This is not meant to be a definitive list.
5 Unspoken Truths regarding weight stigma
Health At Every SizeⓇ (HAES)
Podcasts:
iWeigh – Toxic Diet Culture with Dr. Joshua Wolrich
Maintenance Phase – debunking the myth of BMI
Ed on ED – Dr. Ed Tyson has been a guest on several podcasts about eating disorders and has his own treatment center in Texas as well as serving on the advisory board at Within Health – here is one such episode that I thought was helpful: What People with Eating Disorders Want You To Know
PeaceMeal – the Dangers of Clean Eating
Books:
More Than a Body by Lindsay Kite, PhD & Lexie Kite, PhD
Body Kindness by Rebecca Scrichfield, RDN
Unapologetic Eating by Alyssa Rumsey, MS, RD
Anti-Diet by Christy Harrison, MPH, RD
Intuitive Eating by Evelyn Tribole