Health comes in every size.
Historically, of course, society has not embraced that kind of mentality. Instead, we’ve been led to believe that “thin is in” and that losing weight is the gold standard of good health.
Until recently.
Health at Every Size (HAES) is a social justice movement that was started in the 1960s by a group of activists. It seeks to de-emphasize weight loss as a health goal and reduce the stigma toward people who are in larger bodies. The Eating Disorders Team at Lindner Center of HOPE has adopted HAES internally and are championing the movement in the local community. They believe that health is a result of positive lifestyle behaviors that are independent of body weight.
“Weight fluctuations over time, eating habits, exercise habits, and the presence of yo-yo dieting all account for a great deal of the association between weight and negative health outcomes,” says Elizabeth Mariutto, PsyD, CEDS-S, Clinical Director of Eating Disorder Services at Lindner Center of HOPE. “The HAES movement is working on helping people be aware of the impact of weight stigma on patients and helping them see that they don’t have to lose weight to get to a better place of health.”
One major downside of dieting and the pursuit of weight loss is the risk of developing eating disorders. According to Harvard School of Public Health, 9% of those in the U.S. suffer from eating disorders, which equates to 28.8 million people.
“Regardless of reported numbers, it’s probably a gross underestimate,” says Anna Ward, M.S., APRN, PMHNP-BC, Psychiatric Nurse Practitioner at Lindner Center of HOPE. “A lot of people are flying under the radar, and are even being praised for their eating disorders, because of society’s unfounded belief that smaller body sizes equate with health.”
According to Allison Mecca, PsyD, Psychologist at Lindner Center of HOPE, many who develop eating disorders already have perfectionistic, people-pleasing, and driven personalities. “These personality traits intersect with genetic vulnerability and environmental factors. When this trifecta is in place, dieting or weight loss triggers the eating disorder.”
For example, the rise in popularity of cosmetic procedures and the use of filters and photo editing in social media only further unrealistic standards of beauty perpetuated in our culture.
“To attempt to fit in and feel connected with others, many strive to meet this standard,” Mecca explains. “This can be especially challenging for those who already have perfectionistic personality traits.” When they inevitably cannot meet this standard, they are filled with feelings of inadequacy. While the goal may have been to fit in and feel accepted by others, their efforts can thwart this goal.
While it may appear that they are trying to be better than others, what it boils down to for those with perfectionist personalities is a desire to feel connected, heard and understood.
“They want to feel like they can be their authentic selves, but their perfectionistic drive is actually interfering with that connection,” Mecca says.
Ultimately, it’s about being more self-aware by paying attention to how often you talk about diet or body shape. A comment as innocent as “Hey, you look great!” can be enough fuel for developing an eating disorder. Though it sounds positive, it ties self-worth to body weight and appearance.
“It’s better to comment on personality, rather than appearance,” says Chelsey Zulia, LPC, NCC, Eating Disorders Counselor at the Lindner Center of HOPE. “It’s better to say, ‘It’s so good to see you,’ or ‘I’ve missed your laugh.’”
It Starts Early
Sadly, negative body image issues in children often start as early as three years old.
Lindsey Flannery, RDN, LD, Dietitian at Lindner Center of HOPE, primarily sees adolescent patients. They talk about being influenced by coaches who discuss weight due to sports performance, and health teachers who share tips on how to track calories. Sometimes it’s parents who put their children on a diet because they’re concerned about their weight.
School staff such as teachers, coaches, and nurses may be well-intended but score poorly in execution. For instance, Mariutto has heard countless patients talk about how they were forced to step on a scale in front of classmates, then their weight was yelled out in front of their peers.
“Body shaming and the push toward dieting is problematic for more than just those with eating disorders,” she says. “It’s discouraging how much momentum is behind the ‘war against obesity,’ yet that is not really the main issue. Body shaming exacerbates unhealthy eating patterns and perpetuates struggles with self-worth. Both of these lead to further physical and psychological problems.”
Adds Flannery, “While people may have the best of intentions, something as benign as labeling certain foods as ‘healthy’ and other foods as ‘unhealthy’ can cause problems. Saying, ‘We only have whole grains in this house’ or ‘We don’t do sugar’— those types of things are ingraining messages in kids so early that it deletes intuitive eating at an early age.”
Even medical doctors sometimes struggle with the big picture of health and, as a result, do their patients a disservice.
Mecca works with a patient who has made great strides in recovering from her eating disorder and is physically and psychologically healthy. This patient recently visited her primary care doctor, and when he took a look at her BMI chart, he told her that she could stand to lose five pounds. While some doctors use BMI as the indicator for a healthy weight, BMIs are incredibly arbitrary and, in fact, were never meant to be used for individual health indicators. Research has shown that people of different body sizes can be healthy at whatever weight they are.
It’s important to recognize that doctors are human beings who grew up in this society, too, Eating Disorders Team members agree. Medical providers often reference research that a larger body is associated with numerous health outcomes, although many do not question if the weight is the cause. Often, it is not. Eating habits and exercise are not always thoroughly screened, and telling someone to diet is not only unhelpful, it’s harmful.
Research has also shown that physicians spend less time with those in larger bodies and that patients often feel all of their problems are blamed on weight. It leads patients to feel unseen and, as a result, many who are in larger bodies avoid doctor visits.
Mindful Eating
The truth is that it’s not about good foods/bad foods. Everything is OK in moderation, the Eating Disorders Team continues.
Mindful eating gives you permission to eat anything you like. When you are aware of how different foods make you feel, you will naturally gravitate toward certain things and not others. When we apply good or bad/healthy or unhealthy language toward food, however, it can lead to cycles of restriction and overeating, as well as shame.
And more often than not, dieting backfires — 95% of those who lose weight gain it back and more within one to five years.
Dieting Industry’s Impact
In 2019, the dieting industry made $79 billion — proof that people are profiting off weight loss. Furthermore, Ward points out, dieting is one of the only interventions where we blame ourselves when it doesn’t work.
“If you go to the doctor because you’re nauseated and they tell you to take a particular medication, but it doesn’t help your nausea, you’re not going to say that it’s your fault your body didn’t respond,” explains Ward. “But when we do these diets — often at the recommendation of our health care providers — and they are unsuccessful, we never think maybe the fault is with the diet. Instead, we always think the fault lies within ourselves.”
The wellness culture that has been created decrees that “X” is what you’re supposed to weigh, but experts agree that the number is not what you should focus on. Better indicators of health can be bloodwork, vitals, psychological well-being, and overall eating and exercise habits.
“I think as much as we can stay away from numbers on a scale and even clothing sizes, and instead focus more on how we are feeling, that’s a good first step,” Ward says. “It should be about what your body needs and how it responds to movement and nutrition.”
Emphasize Self-Care
Zulia says that learning about diet culture and HAES can be jarring. The HAES movement goes against everything we grew up learning and is reinforced by society today.
“It can be so freeing, though, when you’re able to accept that food doesn’t have moral value,” says Zulia. “This is where I hear from patients, ‘I don’t feel like I’m enough.’”
She asks her patients how often they feel that everything is magically better once they have achieved a smaller size, and every single person responds that they are still sad or even that the eating disorder has become “louder.”
“Life can be so different once you release the hold that society has on us,” she says.
According to Mariutto, the societal push for doing whatever it takes to be productive and be promoted also interferes with mental health. Many people skip lunches or work late into the night on a regular basis in attempts to succeed.
“We talk all the time about the importance of self-care, but we aren’t taking that time to take care of our bodies, whether that’s through eating, exercise, or rest,” she says.
Silver Linings
There are, however, some bright spots in our culture. There have been visible shifts in the fashion industry where certain designers and stores now cater to a variety of shapes and sizes. Hospitals are also seeking out information about how they can be more size-inclusive.
“I believe there is hope, and our team is passionate about sparking change in our society,” says Mecca. “But there is more work that needs to be done in the media and our industries to shift the narrative toward body inclusivity and the true meaning of health.”
Celebrate Body Positivity
Anti-Diet by Christy Harrison
Intuitive Eating by Elyse Resch & Evelyn Tribole
The Body is Not an Apology by Sonya Renee Taylor
The Wisdom of Your Body by Hillary McBride