March 15, 2023, noon
Diet Culture and the Belief that Smaller Bodies Automatically Equal ‘Healthy.’ The Perspective from Someone in a Bigger Body, and as Someone Who Works in the Eating Disorders Field.
We live in a society that values thinness. We strive for it constantly because we are told it is more acceptable, and ‘healthier,’ despite this diet culture narrative, many health professionals ask each other, is this completely true? I would argue, no.
For example, in the work that I do within the eating disorders (ED) sphere, I have come across numerous cases where clients are underweight and medically unstable due to an ED, such as anorexia nervosa (AN), but who are often congratulated on how they look by others. They are seen as desirable by societal diet culture standards, and the epitome of all that is ‘healthy’, based on the superficial assumption of their appearance. How wrong and dangerous this thinking can be! Complications of AN may include, a dangerously low heart rate, electrolyte imbalances, multiple organ failure, and much more.
Now, you’d assume at this point that a family doctor would intervene, and yes, some do. However, I can’t tell you the number of times clients have been sent to have ECGs, their heart rates have come back as being shockingly low, yet their family doctor has sent the patient away telling them everything looks fine, and they must just be athletic. But even athletes don’t have heart rates that low. A very low heart rate means that the body, which is energy- and nutrient- deprived, is slowing down essential organ functioning just to keep the individual alive. Sadly, many family doctors are not given enough training in relation to eating disorders, which is the central issue here, but to say that weight bias doesn’t contribute, would also be most likely untrue in many cases. As a result, patients often end up going to hospital, and unsurprisingly, are admitted immediately. So, with this in mind, it’s hard not to see the system, societally, socially, and medically, as being somewhat flawed when it comes to the assumed relationship between body size and health.
Also, looking at societal misconceptions of ED from the other side of the fence, people who are considered ‘overweight’ are assumed to be lazy and unhealthy. But could this thinking be over-generalized, often oversimplified, and at times down right untrue? I say this for a number of reasons. Firstly, there are many people who are not what society assumes to be ‘healthy’ in terms of societal norms and the number on the scale, but who lead active and healthy lives. Yet, they are often not believed. Additionally, when it comes to the variability in a person’s body size, there can be many contributing factors, including genetics. Biologically, people naturally have a higher or lower set point weight than others, which is often overlooked.
Furthermore, with regards to health perceptions, it is often assumed (even by medical professionals) that being bigger bodied is the cause of health issues (if they exist), and dismissed that health issues may actually be the cause of weight gain. People seldom question motives when a person has an illness and weight is unintentionally lost. Immediately this signals doctors to perform additional testing as it is a warning sign of something being very wrong. However, when someone gains weight in the same sort of way, they are told to just eat less and move more, because the bias is that they are doing something to cause their weight gain. There is no rush to test for underlying causes, such as hormonal issues, thyroid issues, and autoimmune issues, which is yet another failure of our weight-centric healthcare system.
Now, yes, there are those people in bigger bodies who develop binge eating disorder (BED), sometimes on its own, sometimes mixed with other existing, contributing factors. However, this is not an exclusive eating disorder for bigger bodied individuals, in the same way that AN or bulimia nervosa (BN) is not exclusive to smaller bodied people. Throughout my time working at an eating disorders clinic, I have seen numerous bigger bodied individuals who have symptoms of anorexia (known as atypical anorexia), and who are just as medically unstable, but who are not admitted to ED treatment programs as their body mass index (BMI) is not considered sufficiently low. Additionally, they are often assumed to be lying, or just not being accurate in reporting the amount of food they are eating, if they say that they are heavily restricting. Not only is this incorrect, but also, it could end up being a fatal mistake.
With the aforementioned arguments in mind, I try my best to advocate for a holistic perspective to body size and its correlation to health; a complex network of contributing factors which need to be more thoroughly explored in a non-judgmental manner, without assumption. Until this happens, many individuals will continue to hit road blocks, both personally and professionally, because societal myths and biases around weight and health will continue to rule the narrative. In the meantime, many people will continue to feel inadequate and unworthy for being in diverse bodies, and will continue to do damage to their bodies through weight cycling (yo-yo dieting), disordered eating, and for some, the development of ED.
Charlotte (She/Her) is a Registered Psychotherapist in Ontario who has experience working in the eating disorders field through a clinic she works at part-time, along with general mental health and addictions treatment within her personal practice. Also, she is someone living in a bigger body, who has personally experienced weight stigma, and its negative impacts. She is passionate about advocating around the fallacies associated with diet culture and body size, and takes a holistic, health at every size based approach when working with clients. Further, within her private practice, she specializes in working with folks in the LGBT2SQ+ community, along with those who are experiencing chronic health conditions. If you are interested in reaching out to Charlotte, her email is firstname.lastname@example.org, or alternatively you can follow her on Instagram at @charlotte.laws.rp
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