Diet Culture, Eating Disorder Recovery, and Health at Every Size®

Eating disorders evolve out of complex, interacting biological, psychological, and sociocultural factors. One consistent barrier to full recovery from an eating disorder is the existing sociocultural obsession with thinness, fear of fatness, and diets. Our society is inundated with messages that are filled with weight stigma and influenced by diet culture — a system of beliefs that not only equates weight (in particular a lower weight) to health, but it moralizes weight. Diet culture makes full recovery from an eating disorder a real challenge.

Why diet culture perpetuates eating disorders

Diet culture perpetuates eating disorders in the following ways:

• It reinforces and normalizes unhealthy behaviors such as restriction and overexercising.

• It narrowly defines health and asserts that health is determined by one’s weight (rather than health behaviors).

• It moralizes weight, meaning that it judges an individual’s human worth based upon their weight as well as finding someone’s weight as a product of their own choices or actions. This perpetuates the false idea that weight is easily controllable and, thus, if you are not at an ideal weight, this is because of a personal failure.

• It’s fatphobic. Fatphobia is a dislike of fat people, finding fat people as inferior to thin people, and/or the fear of becoming fat — all of which fuels disordered eating thoughts and behaviors.

• It encourages body dissatisfaction. Conventional diet-culture thinking suggests that feeling bad about one’s body is what motivates behavioral changes that promote weight loss. However, the opposite is true — body dissatisfaction leads to more destructive, unhealthy behaviors.

• It amplifies psychological traits that lend themselves to eating disorders such as perfectionism, rigid thinking, over-control, fear of failure — if taken to extremes, these traits can be detrimental to one’s well-being.

• Diets can trigger underlying biological mechanisms that cause eating disorders. Diets result in increased food preoccupation and increased hunger cues, as our bodies want to maintain a certain weight. Most diets involve a deprivation of nutrients and therefore lead to a “diet-overeat” or “diet-binge” cycle. Diets are not sustainable because your body will try to get its nutritional needs met by reminding you that you are hungry – headaches, a growling stomach, obsessive thoughts about food – this is your body communicating. It needs more nutrients to function properly. This often leads to eating disorder signs and symptoms, including:
  • Depression, fatigue, anxiety, increased rigidity regarding ‘good’ and ‘bad’ foods, loss of trust in self with food, feeling ‘undeserving’ of food, social isolation or withdraw, and guilt around eating.
  • Research as shown that dieting for weight loss is often associated with weight gain, due to the increased incidence of binge-eating and that 95% of all dieters will regain their lost weight in 1-5 years.
  • Research has also indicated that 35% of “normal dieters” progress to pathological dieting (i.e., disordered eating patterns). Of those, 20-25% progress to partial or full syndrome eating disorders.

• It perpetuates weight stigma, which studies have shown increases disordered eating, results in weight gain, results in low self-esteem and body dissatisfaction, increases depression and suicidal thoughts and behaviors, results in trauma, diverts focus from health behaviors to weight loss/management, increases binge eating, results in eating less nutritious food, increases metabolic risk, increases blood pressure, results in healthcare avoidance and provider distrust (less likely to seek preventative care), and results in missed health diagnosis or misdiagnosis.

What Is Health at Every Size®?

Health at Every Size® (HAES®) is an approach to health that shifts the focus from weight to health. It is a fairly recent philosophy that has emerged primarily since the late 1990s. It is promoted by the Association for Size Diversity and Health (ASDAH), who owns the phrase as a registered trademark.

The primary goal of HAES® is to promote healthy behaviors for people of all sizes. HAES is grounded in five principles:

1. 1. Weight Inclusivity: Accept and respect the inherent diversity of body shapes and sizes and reject the idealizing or pathologizing of specific weights.
   2. Health Enhancement: Support health policies that improve and equalize access to information and services, and personal practices that improve human well-being, including attention to individual physical, economic, social, spiritual, emotional, and other needs.
   3. Respectful Care: Acknowledge our biases, and work to end weight discrimination, weight stigma, and weight bias. Provide information and services from an understanding that socio-economic status, race, gender, sexual orientation, age, and other identities impact weight stigma and support environments that address these inequities.
   4. Eating for Well-being: Promote flexible, individualized eating based on hunger, satiety, nutritional needs, and pleasure, rather than any externally regulated eating plan focused on weight control.
   5. Life-Enhancing Movement: Support physical activities that allow people of all sizes, abilities, and interests to engage in enjoyable movement, to the degree that they choose.

Research on HAES® has shown to have the following long-term health outcomes:

• Lower levels of disordered eating
• Improved eating and activity habits
• Improved dietary quality
• Improved mood
• Increased self-esteem
• Improved body image
• Significantly higher retention rates compared to dieting (92% vs. 41% after two years)
• No weight cycling
• Greater resilience to weight stigma
• Lower blood pressure
• Improved lipid profiles
• Increased physical activity

How HAES® supports eating disorder recovery

• It encourages holistic health. Adopting a HAES® approach means understanding that health is made up of many factors and has little to do with any specific weight. It returns the definition of health to one that focuses on health behaviors along with other components of health such as emotional, spiritual, social, environmental, occupational, and intellectual factors.

• It de-centers weight. While weight restoration is a primary goal in restrictive eating disorder recovery, the sole focus of eating disorder recovery should not be on weight. Rather, the focus should be on encouraging regular, flexible, individualized eating based on internal cues such as hunger and satiety. Centering recovery on weight can actually be harmful, especially for those in larger bodies.

• It encourages body respect and acceptance. Body respect and acceptance actually promote healthful behavior. When we respect and accept our bodies, we take care of them. If we focus on caring for our bodies, versus changing them, we can reach our optimal health and well-being.

By rejecting diet culture and embracing the HAES® principles, one can exit the disorder eating cycle and return to their own internal wisdom. As those in recovery actively practice new health behaviors and new ways of thinking, they can work towards full freedom from their eating disorder.

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Sources:

[1] Fielder-Jenks, C. (Dec 2017). Thrive Blog. Thinking about starting a diet? First, check-the-facts: Diets don’t work. Retrieved from https://thrivecounselingaustin.com/blog/check-the-facts-diets-dont-work on Feb 6, 2020.
[2] Fielder-Jenks, C. (2019). Size Diversity Competency Training For Healing Professionals Workbook. Retrieved from https://thrivecounselingaustin.com/resources/size-diversity-competency-training-for-healing-professionals-workbook on Feb 6, 2020.
[3] Field, A. E., Austin, S. B., Taylor, C. B., Malpeis, S., Rosner, B., Rockett, H. R., Gillman, M. W. & Colditz, G. A. (2003). Relation between dieting and weight change among preadolescents and adolescents. Pediatrics, 112(4), 900-906.
[4] Grodstein, F., Levine, R., Spencer, T., Colditz, G. A., &Stampfer, M. J. (1996). Three-year follow-up of participants in a commercial weight loss program: Can you keep it off?, Archives of Internal Medicine, 156(12), 1302.
[5] Shisslak, C.M., Crago, M., & Estes, L.S. (1995). The spectrum of eating disturbances. International Journal of Eating Disorders, 18 (3), 209-219.
[6] Stice, Cameron, R. P., Killen, J. D., Hayward, C. & Taylor, C. B. (1999). Naturalistic weight-reduction efforts prospectively predict growth in relative weight and onset of obesity among female adolescents. Journal of Consulting and Clinical Psychology, 67, 967-974.
[7] Bacon, L. & Aphramor, L. (2014). Body Respect: What Conventional Health Books Get Wrong, Leave Out, and Just Plain Fail to Understand about Weight. Dallas, TX: BenBella Books.
[8] Association for Size Diversity & Health. HAES Approach. Retrieved from https://www.sizediversityandhealth.org/content.asp?id=152 on Feb 23, 2019.
[9] Bacon, L., & Aphramor, L. (2011). Weight Science: Evaluating the evidence for a paradigm shift. Nutrition Journal, 10(1). doi:10.1186/1475-2891-10-69
[10] Bacon, L. (2008). Health at Every Size: The Surprising Truth About Your Weight. Dallas, TX: BonBella Books.

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About the Author:

Chelsea Fielder-Jenks is a Licensed Professional Counselor in private practice in Austin, Texas. Chelsea works with individuals, families, and groups primarily from a Cognitive Behavioral Therapy (CBT) and Dialectical Behavior Therapy (DBT) framework.

She has extensive experience working with adolescents, families, and adults who struggle with eating, substance use, and various co-occurring mental health disorders. You can learn more about Chelsea and her private practice at ThriveCounselingAustin.com.

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The opinions and views of our guest contributors are shared to provide a broad perspective on eating disorders. These are not necessarily the views of Eating Disorder Hope, but an effort to offer a discussion of various issues by different concerned individuals.

We at Eating Disorder Hope understand that eating disorders result from a combination of environmental and genetic factors. If you or a loved one are suffering from an eating disorder, please know that there is hope for you, and seek immediate professional help.

Published February 27, 2020, on EatingDisorderHope.com
Reviewed & Approved on February 27, 2020, by Jacquelyn Ekern MS, LPC