How Diet Culture Feeds Weight Bias and Stigma
The diet industry has influenced the way we view our bodies and health—and the end result is less than favorable. In this article, Caitlin Beale, MS, RDN, examines the role of diet culture and its influence on weight and food bias.
Have you spent your life jumping on and off the latest diet trend more times than you can count? You aren't alone.
According to a recent market research report, the diet industry was worth 192.2 billion dollars in 2019, with projections of reaching almost 300 billion dollars by 2027.
But it turns out that diets don't work, especially long term. In reality, diets may increase the risk of obesity and weight gain over time. So not only are we wasting our money, but the diet industry has also influenced the way we view bodies and health—and the end result is less than favorable.
This article examines the role of diet culture and its influence on weight and food bias. You'll learn how the diet industry has negatively influenced how we view health and wellness and how this message set the stage for weight bias and stigma.
What Is Diet Culture?
Diet culture encompasses the belief that achieving thinness is the ultimate goal for every person. It doesn't matter the path you take to get there, just as long as your body shape or appearance matches a thin ideal.
In the world of diet culture, the only expression of health is a thin body, and those who can't achieve it are considered somehow unworthy, less motivated, or lazier than those with smaller bodies.
Diet culture blames the individual for their inability to achieve this ideal and ignores the fact that research overwhelmingly suggests that diets and dieting rarely translate to long-lasting weight loss.
In the view of diet culture, food is no longer eaten for pleasure or nourishing your body. Calorie restriction or categorizing foods into “good” or “bad” is recommended for everyone across the board.
It doesn't matter what your labs look like or if you are the picture of metabolic health with fantastic bloodwork, good sleep and exercise patterns, and low stress levels. Diet culture suggests that you can't possibly be a healthy person without being thin.
Avoiding a specific food for a medical condition like dairy because of lactose intolerance or gluten because of celiac disease is not diet culture. There's also nothing wrong with eating or avoiding certain foods to feel better physically. But because of diet culture's influence, it's challenging for many people to separate how food makes us feel from how food influences our weight.
Is the Wellness Industry Connected to Diet Culture?
Achieving wellness—defined as the state of being in good health—can be separate from diet culture, but you have to pay attention to the source.
Sometimes, certain wellness programs or products are disguised as an answer to diet culture. But it's a slippery slope and may just be diet culture in disguise, as illustrated by the recent controversy with the weight loss program Noom.
Controversy with Noom
As a disclaimer, I have never tried Noom, so I'm sharing the experience of others. In the past, I heard mainly positive things about Noom because it advertises itself as an alternative to dieting by focusing on mental health and behavior changes for weight loss.
But a recent Twitter thread (with many responses) suggests that Noom is just as guilty as any other weight loss product. Users revealed the product prescribes a low calorie goal for most people while giving suggestions and tips that make reducing the number on the scale the primary goal.
Diet Culture Exists Everywhere
Noom may be in the news, but the ties between wellness and diet culture exist everywhere. In practice as a dietitian, I've seen how easy it is to take a diet, packaged as a healthy lifestyle, too far. Whether it's Whole30, keto, or whatever the next popular diet may be, eating patterns that draw a hard line on what you can and cannot eat without wiggle room make it easy to fall into disordered eating habits.
Either you follow them so strictly you flirt with orthorexia (an unhealthy obsession with eating healthy), or you end up with immense feelings of guilt if you don't follow the plans perfectly.
Not everyone who follows these diets will have a bad experience. Wellness plans can even help encourage positive eating habits like more fresh fruits and vegetables for some people. But it's a fine line.
Wellness also doesn't look the same for every person. Your individual responses to food, genetics, environment, and socioeconomic status matter, and many programs don't consider these personal differences.
As Dr. William Dixon, emergency medicine physician and cofounder of Signos points out, "Health is about much more than weight or BMI. Diet culture doesn’t necessarily care about the individual person and what their body is capable of, or in what context they have found or lost their health. People will have a different healthy weight range, even if that is not what aesthetics or culture dictates.”
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Dangers of Diet Culture
In reality, dieting based on restriction of any type, whether severely restricting calories or cutting out a food group, doesn't last.
“Anything designed to be temporary is by definition likely unsustainable,” says Dr. Dixon. “If your goal is to lose three pounds before a vacation, that’s different. But long-term weight loss and maintenance requires consistency above all. For many people, that means building a healthy relationship with food, sleep, and physical activity.”
An older but significant National Institutes of Health (NIH) study found that up to two-thirds of weight loss in weight loss programs is regained within a year, and for most people, almost all is regained within five years.
Aside from frustration, why does it matter that diets don't work? It starts a vicious cycle that begins with restriction. Soon, you fall off the diet, end up overeating and gaining weight, and become even more preoccupied with food. The more it happens, the more weight you regain the next time.
Part of the reason this happens is that when you diet your body adapts to protect itself from going too long without nutrients. As you lose weight or cut back on calories, hormones in charge of your appetite start to shift. Ghrelin, the hormone that makes you hungry, can increase as your body urges you to eat, while leptin, the hormone that helps you feel full and satisfied, drops.
The result? You feel hungrier, not only because you've cut calories but also because your hormones stimulate appetite.
Diet culture doesn't just set us up to feel like failures for not staying on the path. It also increases the chance that we, or someone watching us (like our children), will develop disordered eating habits, have low self-esteem, or experience mental health issues.
Weight Bias and Weight Stigma Are Connected to Diet Culture
Since diet culture worships a thin ideal, it's directly connected to weight bias and weight stigma:
- Weight bias (or anti-fat bias) is the negative thoughts and beliefs about people with larger bodies.
- Weight stigma is the social or label prejudice towards someone because of their body size that affects how someone is treated.
Weight stigma and weight bias both exist because of diet culture. Weight stigma, or the actual treatment of a person based on their size, stems from weight bias.
And because of diet culture, from the images we see every day in ads and the messages we hear in media and pop culture, bias is often built into our unconscious without realizing it.
Some studies even suggest that discrimination based on weight is as common as racial discrimination.
What Are the Dangers of Weight Stigma?
From bullying to inequalities in employment or education, weight stigma shows up everywhere. But weight stigma especially influences the treatment and perception of people in healthcare and pop culture.
Weight Stigma in Healthcare
Perhaps one of the most dangerous consequences of weight stigma is that it affects whether someone will seek medical care—even annual physicals. Lack of preventative care increases the risk of chronic physical and psychological health conditions that could otherwise be caught early (at any body size). Alternatively, health care providers may assume that people within a normal BMI might not need screening or testing. However, a small percentage of people with type 2 diabetes, hypertension, and dyslipidemia are in the normal BMI range.
If someone believes they will be shamed for their body weight, they are much less likely to visit a doctor, leading some scientists to suggest that weight stigma could be more harmful to health than having a higher body mass index. This harm may be due to acute stress or even missing out on important health screenings, which can lead to missed diagnoses. “BMI is an easy thing to measure, and is important as a screening tool and in population health,” says Dr. Dixon. “But for an individual person, there are many other health inputs that matter as much or more. We are obliged to go beyond BMI when looking at metabolic health.”
Anti-fatness in healthcare has been studied to see how it impacts care. One study found that providers spend much less time with larger-bodied patients than those categorized as normal weight. Another review found that providers are more likely to use obesity as a reason for symptoms and suggest losing weight instead of recommending further tests or treatment options.
The message that having excess fat equals poor health is one that nearly everyone accepts. But simply being larger doesn't mean that someone is automatically unhealthy or that extra body weight is the reason they are having symptoms.
As Dr. Dixon shares, “There is an unfortunate tension between recognizing that excess metabolically active adiposity has correlative disease states, but that obesity is rarely the proximate cause of most of the acute complaints that we see in medicine. Losing weight does not always immediately fix a specific problem. Because weight has such personal and societal implications, it is hard to discuss weight without involving more than long-term health outcomes. If a patient comes to a physician with a concern and is met with an unwanted discussion about the necessity of weight loss, they could feel unheard on multiple accounts.”
So what happens instead? As mentioned above, people with larger bodies or higher BMI are less likely to see a doctor because they don't want to be discriminated against because of their weight. This increases the risk of developing health conditions, not necessarily because of body size, but because people are understandably avoiding routine medical care that could help prevent disease in the first place.
Weight Stigma in Pop Culture and Media
Even more pervasive are the daily diet culture messages we receive from pop culture that deepen weight bias. It's everywhere. And much of what we learn about social norms, attitudes, and beliefs we get from the media.
Characters in larger bodies are often portrayed as the lazy, not-so-bright sidekick, especially in children's media, which sets the stage for weight bias from a very early age.
Perhaps even more apparent is the representation of who is considered successful or happy in television or movies. It's usually the thin character, illustrating diet culture at its “finest.”
What Can We Do to Combat Diet Culture?
For the individual person, diet culture and weight bias can seem too large to take on. But like anything else, making a change starts with one person at a time. It can take time and mindfulness to change perception if you've spent a lifetime feeling like food is an enemy, and the only way to achieve true wellness is to meet a certain number on the scale.
Again, a desire to make diet changes to benefit your health and longevity is entirely different from diet culture (but they can get confused if we aren't paying attention). Sometimes weight loss happens when you make adjustments, even if losing weight wasn't your primary goal.
For example, maybe you've learned you have blood sugar dysregulation, so you decide to focus on adding more fiber to your diet because it can help minimize blood sugar spikes. Suddenly you feel more satisfied with your meals and find yourself snacking less often. Your goal wasn't about taking away snacks or even eating less, but you ended up eating less due to the added fiber.
You can begin by thinking about your own feelings towards diet culture. Have you personally struggled with dieting? Have you spent your life stressing about food, jumping in and out of unsustainable diets that only focus on your weight as the outcome? How has that influenced how you feel about food?
Further, you can be honest with yourself about weight and body size. Do you equate your weight (or other people's) with self-worth? Can you separate health markers—blood sugar balance, healthy lipids, cognitive function, sleep, physical fitness—from what the scale says?
Simply becoming aware that diet culture, weight bias, and weight stigma exist is a step in the right direction.
In part two of this series, we will examine how diet culture influences food and how we decide what to eat—stay tuned!