Diet culture is present in any society that values thinness and individuals in smaller bodies over those in fat, or larger bodies. It promotes restriction (even when it has been shown to be harmful) and weight loss above health and wellbeing. Intentional weight loss (i.e. dieting) is actually associated with weight gain in the long term. Dieting is a socially acceptable form of restriction.
Diets don’t work for sustaining long term weight loss. This is a well-researched conclusion (see linked article). The body wants to protect us. When we restrict, our bodies think we are in a state of famine and want to conserve as much fat and energy as possible by fiercely holding onto weight. When we restrict, our bodies do not know the difference between a famine and a diet, and so often, binge eating occurs as your body worries about when its next source of energy will be. Because diets don’t work, often a pattern will emerge of dieting and restricting to bingeing and regaining weight. This is called weight cycling. When we eat intuitively, our bodies are able to trust and know that food is available, instead of going into fear mode, craving and bingeing on foods to store energy for the next period of restriction. Thus, our bodies tend to move towards a set, stable point when they are adequately and routinely nourished, also resulting in decreased feelings of craziness around food.
Weight stigma is another real problem that has negative health effects. Healthcare practitioners ought to work towards having a more respectful, inclusive, and compassionate understanding of the tangible health impacts that stigma has on individuals in larger bodies. For example, many fat people feel scared / anxious about doctor’s visits because they worry their problems will be overlooked and minimized by being told to simply lose weight. Weight loss is often prescribed as a “fix-all” solution, and typically ends up doing more harm than good (lower motivation for movement, getting caught in the binge-restrict cycle -> weight cycling, increased anxiety and activation of the stress systems in the body, and lowered self-esteem).
The Reality of Size Diversity
The truth is that we all have a set point weight where our bodies feel most comfortable and function best. This set point weight is different for everybody, and is a combined result of several factors (i.e. genetics, environment, access to food and resources, etc.). Even if we all adhered to the same diet and moved in the exact same ways, our bodies would still look very different. This is a good and beautiful thing; diversity is a beneficial addition to our society. It is our culture that has demonized this natural diversity of bodies and made some bodies “good” and others “bad.”
Because of this demonization of fat bodies, we have come to view smaller as better, and given certain privileges to those in smaller, thinner bodies. This is a phenomenon called thin privilege. Thin privilege rewards those whose bodies are smaller while vilifying fat. This shows up in the ways that we treat smaller people better, how we equate beauty standards with thinness, and in healthcare, where millions of people are stigmatized and denied proper care simply because of the size of their bodies.
Trends like “clean eating” and “lifestyle changes” have replaced the term “diet” in more recent years. Many of us have figured out that diets don’t work, especially the diet industry, and so in the last decade or so, diets have undergone a large rebranding as “wellness.” Wellness is a trendy term that often is misused as a coverup for the diet industry. If it touts body changes as the key to happiness, it is a diet. If it claims to be body positive, but does not address social injustices and systematic inequalities, look elsewhere. True holistic wellness values and respects the individual, understands that weight is not a good indicator of health, and upholds a standard of compassion and care for the individual looking at multiple factors including socioeconomic status, resources and access, and evidence based treatments.
Disordered eating vs EDs
Disordered eating is a pattern of behaviors such as restriction, compensatory behaviors, and avoidance of foods (due to texture or fear of its impact on the body, etc.). An eating disorder results from continual engagement in these behaviors at a defined frequency over a period of time, and is considered clinical because of the frequency and length of engagement. However, the diagnostic manual for the diagnosis of eating disorders is flawed and does not fully capture the harm done by engaging in disordered eating patterns for any amount of time.
Disordered eating patterns are harmful to the body as they are what make up eating disorder behaviors. Even if they are not engaged at a “clinical” level, they can be pathological. For example, self-induced vomiting can lead to tooth enamel erosion, acid reflux, and imbalances in electrolytes. Over-exercising can put a strain on the body and lead to pulled muscles and fatigue. Restriction at any size can lead to skewed hunger and fullness cues, binge eating, and frustration.
Why HAES + IE is the best treatment
Intuitive eating is a set of principles that help individuals to have a more flexible and intuitive relationship with food and their bodies. Intuitive eating is about honoring our hunger and fullness cues, incorporating satisfaction, community, + joy in the eating process, and respecting our bodies as they change and support us. Intuitive eating and a Health at Every Size approach are associated with improved health outcomes including decreased engagement in disordered eating behaviors, improved body image, and lowered blood pressure. A Health at Every Size approach is the best framework for healthcare providers because it acknowledges and works towards the improvement of fractured and unjust systems (i.e. diet culture and systematic racism) and makes steps towards more equitable healthcare for all people in all bodies. Intuitive eating means that we do not have to have a chaotic relationship with food and try to micromanage our bodies. It means we can stop focusing so much on changing, and move towards acceptance so that we can focus on the things that really need addressing like racial injustice and unequal pay. When we stop focusing on our bodies, we are free to focus on our relationships with the people around us, to advocate and fight for social justice, and to really change the world.
Truly caring for clients looks like never recommending intentional weight loss because it is not evidence-based and causes harm. Disordered eating patterns are harmful to all bodies whether engaged in at a “clinical level” or not. All bodies are good bodies, and shape and size do not have moral value. I hope you learned a lot about diet culture, a HAES framework, intuitive eating, and body respect.
With so much compassion,