Health, particularly behavioral health, has become bound up in morality. The term for this is “healthism” based on a philosophy that everyone is responsible for their health but in a way that makes “healthy behaviors” seem to be more morally superior. This is particularly a problem when it comes to body size. There is a feeling that if health is under your control, then that means you must be “choosing” to be obese (as defined by body mass index). Often people living in larger bodies, then are blamed for not fitting into the “healthy ideal.
Obesity is thought by many to be preventable and people in larger bodies are then stigmatized as being “lazy, over-indulgent or lacking in self-control.” This is despite the many studies that demonstrate the complexity of the problem of weight. Research has shown conclusively that diets don’t work and medical science has been biased in terms of linking health to a number on the scale. The health-weight association may be more to do with metabolic fitness than with a particular weight. That would point to lifestyle as a better measure of health. However, even here, we have stigmatized foods and given such conflicting advice to people about what to eat and what not to eat that it’s tainted even reasonable nutrition advice.
As noted nutritionist Julie Duffy Dillon RD states in a recent blog: “most industries that do not provide long-term results fail to make it in the marketplace. The diet industry has eluded this marketing regulator. Instead, the diet industry has designed diet pills, meal replacements, plans, calorie counts, gym memberships, etc. that fail for the majority long term.” In fact, a former industry execs at one major weight loss program likened diets to playing the lottery: “If you don’t win, you play again. Maybe you’ll win the second time.”
The problem is that moralizing about health creates weight stigma, which we know leads to discrimination against people of size in many areas of their lives including the workplace, health care facilities, educational institutions, the media and even in relationships and affects children as young as three. The presence of weight stigma has increased by 66% in the last decade, corresponding with the “war on obesity.” Weight stigma is rarely challenged and is felt, by some, to be necessary and justifiable because of this notion of healthism that living in a larger body is your personal responsibility and that it’s possible to shame someone into losing weight.
The prevailing emphasis on personal responsibility as the cause for obesity has been refuted by science. There are many determinants of size that have nothing to do with “calories in vs. calories out.” Included here is the role that genetics and metabolism / biology play in body weight along with social and economic influences that promote weight gain. Here are just a few:
· Increased availability of and decreased cost of calorie dense foods and drinks and increase in prices of fruits, vegetables, etc.
· Many people live in “food deserts” with poor access to grocery stores
· Lack of public transportation in many areas can compromise access to desired foods
· There is a lack of safety and walkability in many neighborhoods
· There is evidence that certain toxins in our environment can also promote weight gain
Beyond these concepts is the notion of body autonomy – generally considered a human right. Body autonomy means a person has the right to control their own bodies. This begs the question: “Who are we to tell anyone how they should look, what they should eat and how much they should weigh?”
We have been led to believe that there is a solution for “obesity” and that solution is to diet. However, studies have shown over and over that diets don’t work. A study in 2007 reported 30-60% of dieters gained all they weight they lost. As well, dieters didn’t experience any significant changes in their overall health. Studies that followed dieters for more than 2 years found that 83% gained back more weight than they’d lost. Diets not only do not work, they are a predictor of future weight gain.
In my work with individuals experiencing eating disorders for over 30 years, it is clear that people in larger bodies have often been started on the diet rollercoaster when they were children. Many have literally been on numerous diets and spent thousands of dollars dieting. This along with the weight stigma that many experience has led to low self-esteem for many and has caused them to put their lives on hold waiting for the “perfect body” before they pursue their dreams of a relationship or career goals.
It’s time to acknowledge that weight is NOT a moral issue and that diets will never work in the long-term. As well, we know that you can be healthy no matter your size. Given this, healthism is just another code word for weight loss and is another way of promoting weight stigma and should not be tolerated.
For the person living in a larger body, recognizing that diets don’t work is really about coming to respect and honor your body. This may be work you have to do no matter what you’ve been told by the medical profession which is the #2 purveyor of weight stigma in our culture. There are now many organizations and some physicians and dieticians that promote fat positivity and weight inclusivity. I encourage you to claim your own body autonomy and choose how you want to live and be healthy in the body you have.
Please note this article has used the words “obesity” and “overweight” in the context of research or as defined by BMI. It is not meant to be offensive.