Ghosts of Diet Culture Past

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This is part of a three-part end of the year series that will discuss the past, present, and future of diet culture.

A common refrain is that being higher-weight is “linked” to health issues. We have discussed before how, even if higher-weight people do experience health issues(s) more frequently, that doesn’t mean that being higher-weight causes the health issues, nor does it indicate that weight loss would decrease the risk. Another variable or variables could be what is causing the health issues, including weight cycling, weight stigma, and healthcare inequalities. Mistaking correlation between weight and health issues for causation is part of what creates a harmful (sometimes fatal) cycle wherein the healthcare system creates weight cycling, weight stigma, and inequalities, then blames fat bodies for the negative outcomes causes by them, then uses those negative outcomes to justify more weight cycling, weight stigma, and access inequalities.

But there are more layers to this. The focus of the healthcare profession is often on fat people’s current habits (the experience of having not just our weight, but any health problems we have blamed on (what they assume are) our behaviors and  told to “eat less and exercise more” by a doctor who didn’t have any information about what we ate or how much we exercise.)  Today I want to talk about specific experiences that have been foisted onto fat people in the past that my impact our current health and for which our bodies will typically be blamed.

Low-fat dieting

The concept of low fat dieting has been around since the 1940’s and is still recommended/followed by some people (including healthcare practitioners) today, but it had its heyday starting in the 1980’s. This trend suggests that eating low or no-fat foods would lead to weight loss. It saw a significant rise in low and no-fat versions of foods, everything from fat-free sour cream to the ubiquitous “Snackwells” products. There is not a single study suggesting that low-fat dieting actually leads to long-term, significant weight loss. My question here is about the harm. In addition to the harm of weight cycling, this seems like a way of eating that is custom created to trigger and/or exacerbate blood sugar issues for a couple of reasons. First, because the low and no-fat products often had more sugar, and second because fat helps to mitigate blood sugar spikes. While there is nothing wrong with sugar, in someone with a predisposition to developing blood sugar disregulation, eating more sugar or carbohydrates with less fat can exacerbate blood sugar issues.

Lack of insurance coverage

Prior to the Affordable Care Act (Obamacare,) health insurance companies in the US were, in many circumstances, allowed to refuse to cover “pre-existing conditions.” One of those “conditions” was a high Body Mass Index. This meant that insurance companies could simply refuse to offer insurance to higher-weight people. Of course, there are many people who still can’t access health insurance in the states (which is inexcusable) but when it comes to fat people, we have to wonder how many health issues came from a lack of access to care.

Delayed care

Delays of care can cause missed diagnoses, and worsened health issues and outcomes. This is exacerbated when outcomes between thin people and fat people are compared directly, without taking into account that the thin people received ethical evidence-based treatments immediately while fat people’s care was delayed. Then when fat people come back with more advanced health issues or negative outcomes, those are blamed on fat bodies rather than on the delay of care.

Delay of care can happen in several ways:

A fat patient goes to the doctor to discuss specific symptoms/concerns and the healthcare practitioner hijacks the appointment to talk about weight and weight loss.

A fat patient is told that before they start medication or other treatment protocols (that thin people would be given immediately) they must try to lose weight, delaying their care for an indeterminate amount of time, possibly forever.

A fat person is denied a procedure due to BMI limits (a subject that I’m working on an in-depth series about.)

After a long history of having their health issues denied in lieu of suggestions of weight loss and body shaming, fat people delay going to the doctor when new symptoms emerge because they’ve learned that there is no point.

The So-Called Ob*sity “Epidemic”

We know that the most common outcome of intentional weight loss is total weight regain. Research, including Mann and Tomiyama 2007, finds that up to two-thirds of those who regain to baseline go on to gain back more weight than they temporarily lost.

Now, there’s nothing wrong with being fat or getting fatter. The issue is that weight loss has been recommended to fat people for decades, progressively earlier, more often, and more aggressively (looking at you “very low calorie diets”) with research consistently showing that the most common outcome is weight gain. And the same people who are pushing intentional weight loss are hand-wringing about how people are fatter now than they were and suggesting that what we need is…wait for it…more (and more aggressive) intentional weight loss attempts. Claiming that fat people just existing in the world is an “epidemic” is pure weight stigma, but prescribing something that makes people fatter and then acting shocked that people are fatter is beyond ridiculous.

This may have started off as a con perpetuated by the diet industry, but over time they have managed to recruit or dupe healthcare providers, researchers, and others who should absolutely know better into this sheer nonsense.

The ghosts of diet culture past are still haunting us. They can hurt anybody, but they do the most harm to the highest weight people and those who have multiple marginalized identities. We should have done better then, we need to do better now.

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More Research

For a full bank of research, check out https://haeshealthsheets.com/resources/

*Note on language: I use “fat” as a neutral descriptor as used by the fat activist community, I use “ob*se” and “overw*ight” to acknowledge that these are terms that were created to medicalize and pathologize fat bodies, with roots in racism and specifically anti-Blackness. Please read Sabrina Strings: Fearing the Black Body – the Racial Origins of Fat Phobia and Da’Shaun Harrison: Belly of the Beast: The Politics of Anti-Fatness as Anti-Blackness for more on this.