Written by Ayron Walker, dietetic intern and PhD candidate
Hey Mountaineers! I hope you enjoyed your Spring Break and are feeling ready to tackle the end of the semester. For this month’s Dietitian Dish blog post, we will be discussing dieting and weight and how it relates to “health” (picture me doing air quotes, as health is a term that means different things for different people). Essentially, promoting diet and weight is subsequently influencing disordered eating and eating disorders. Let’s jump in, shall we?
What is Health?
Health is complex. There are many factors that influence health, including age, nutrition, social support, socioeconomic status, genetics, history of dieting, physiological factors, physical activity, sleep, cultural influences, race/ethnicity, and medications. These considerations can affect your weight, which is the primary indicator of health among professionals. Weight is one of the two components to the Body Mass Index (BMI) calculation (weight divided by height squared), which is used to assess for underweight, normal weight, overweight, and obesity. Since the 1970s, BMI has become a proxy for a person’s health status. Using BMI and weight as primary indicators for health has led to obesity being consider a “lifestyle-disease” that will lead to death due to the inability of individuals to self-regulate (i.e. willpower) 1. However, this is untrue, with even current research not able to find a causal link (meaning a cause and effect) between obesity and the leading causes of death in America (Type 2 Diabetes, heart disease and certain forms of cancer) 2. An estimated 74,936,678 United States adults are misclassified as unhealthy when using BMI as the primary assessment 3. This misclassification has numerous concerns including “yo-yo” dieting, economic inequalities, stigmatization, and negative mental and physical health consequences 3.
Further, Dr. Tomiyama, director of UCLA’s dieting, stress and health laboratory, states that there are tens of millions of people who are overweight and obese that are perfectly healthy 3. Unfortunately, individuals who have been labelled as obese (through BMI) generally are more likely to face social stigma and social restrictions due to their weight when compared to individuals without obesity 1. For example, the stigmatization of fat bodies has been shown to impact socioeconomic factors, and barriers to care inequalities, particularly among women 4. Additionally, early estimates of weight stigmatization and discrimination among fat bodies averages about 40% or higher 5-7. Society and many healthcare professionals place blame on obese individuals for their weight (even though we know weight and health is complex), with a common message that weight stigmatization is justifiable because fat people at personally responsible for their weight 5-8. Moreover, some suggest that stigma serves as a useful tool to “motivate” fat people to adopt healthier lifestyles 6. A potential outcome of medical professionals shaming individuals to take personal responsibility for their weight is weight cycling or “yo-yo dieting,” which is a common occurrence in overweight and obese individuals 9.
Unfortunately, many individuals who try to lose weight through dieting are unlikely to maintain long-term weight loss 9. Additionally, repeated periods of weight loss and regain may increase the risk for developing heart disease or Type 2 Diabetes to a greater extent than remaining at a stable weight at a higher BMI 9,10. Further, dieting has become common and normalized in our society, which is seen in children as early as five years old 11. Strikingly, dieting can be one of the strongest precursors and predictors to disordered eating (symptoms of dysfunctional eating patterns such as fasting, dieting, vomiting, over-eating, binge eating, laxative use and pills, and eating disorders) 11. For example, the National Eating Disorders Association reports that 20-25% of individuals of the 35% of “yo-yo dieters” progress to developing an eating disorder 12. Additionally, dieting can lead to depression and anxiety, overeating and binge eating behaviors 12. Disordered eating behaviors are severe with some outcomes including: a clinical eating disorder diagnosis (anorexia nervosa, bulimia nervosa, binge eating disorder, and other specified feeding and eating disorders), a reduction in bone density, fatigue and poor sleep quality, GI problems, headaches, muscle cramps, feelings of shame, depression, anxiety, and nutrition deficiencies 12.
Currently, a national prevalence of disordered eating is unknown, yet studies observing the college student population and athletes in a variety of countries suggest the prevalence ranges from about 5-30% 13-15. Moreover, according to a statistical summary of dieting and disorder eating by the National Eating Disorders Association, 35-57% of adolescent females engage in dieting, fasting, self-induce vomiting, diet pills or laxative, in which overweight girls are more likely than normal weight girls to engage in extreme diets 12. These predictions are shocking and cause for concern since dieting and disordered eating are the strongest predictors for eating disorder development. Recently, it is suggested that 30 million Americans have a diagnosed eating disorder 12. Astoundingly, eating disorders have the second highest mortality rate of all mental health disorders behind opioid addiction 12.
Eating Disorder Risk
The risk for eating disorder development is severe and should be taken seriously. Prescribing diets and continuing to fund diet culture (Americans spend over $60 billion on dieting and det products each year) 12 as a normative belief, is feeding weight stigma and “yo-yo dieting,” which are the strongest predictors of eating disorders. Therefore, weight should not be the primary indicator of someone’s health status nor should weight loss be the primary concern of becoming “healthy.” We should discuss, at a young age, gentle nutrition, and physical activity, and provide access to mental health and financial resources to promote health. Gentle nutrition and physical activity describe eating and moving your body in ways that are mentally, emotionally and physically healthy and satisfying for your body. This is the 10th component of intuitive eating, which is “a self-care eating framework" that integrates instinct, emotion and rational thought and was created by two dietitians, Evelyn Tribole and Elyse Resch, in 1995. Intuitive Eating is a weight-inclusive, evidence-based model with a validated assessment scale and over 100 studies to date. 16 More healthcare professionals should access and complete the training in intuitive eating to provide a more weight-inclusive, self-care approach to health.
Additionally, frequent assessment of healthcare providers should take place to ensure individuals are receiving destigmatized, individualized care. Furthermore, professionals should be provided continued education to learn how to identify eating disorders 12. Health curriculum for young adults should be evaluated by a multidisciplinary care team (mental health counselors, registered dietitians, exercise physiologist, eating disorder specialist and physicians).
Overall, we need to hold each other accountable to end weight stigma and view weight through a health equity and inclusive lens. That’s all for now, folks…until next time!
- Tapking C, Benner L, Hackbusch M, Schüler S, Tran D, Ottawa GB, et al. Influence of Body Mass Index and Gender on Stigmatization of Obesity. Obesity Surgery. 2020;30(12):4926-34.
- Censin JC, Peters SAE, Bovijn J, Ferreira T, Pulit SL, Mägi R, et al. Causal relationships between obesity and the leading causes of death in women and men. PLoS genetics. 2019;15(10):e1008405-e.
- Tomiyama AJ, Hunger JM, Nguyen-Cuu J, Wells C. Misclassification of cardiometabolic health when using body mass index categories in NHANES 2005–2012. International Journal of Obesity. 2016;40(5):883-6.
- Lee JA, Pausé CJ. Stigma in Practice: Barriers to Health for Fat Women. Frontiers in psychology. 2016;7:2063-.
- Andreyeva T, Puhl RM, Brownell KD. Changes in perceived weight discrimination among Americans, 1995-1996 through 2004-2006. Obesity (Silver Spring). 2008;16(5):1129-34.
- Puhl RM, Heuer CA. Obesity stigma: important considerations for public health. American journal of public health. 2010;100(6):1019-28.
- Puhl R, Brownell KD. Ways of coping with obesity stigma: review and conceptual analysis. Eat Behav. 2003;4(1):53-78.
- Rubino F, Puhl RM, Cummings DE, Eckel RH, Ryan DH, Mechanick JI, et al. Joint international consensus statement for ending stigma of obesity. Nature Medicine. 2020;26(4):485-97.
- Strohacker K, Carpenter KC, McFarlin BK. Consequences of Weight Cycling: An Increase in Disease Risk? International journal of exercise science. 2009;2(3):191-201.
- Hill AJ. Does dieting make you fat? Br J Nutr. 2004;92 Suppl 1:S15-8.
- Behavioral Nutrition. The Prevalence of Eating Disorders in America 2018 [updated 2018-09-20. Available from: https://behavioralnutrition.org/the-prevalence-of-eating-disorders-in-america/.
- National Eating Disorders Association. Statistics & Research on Eating Disorders. 2018.
- Tozun M, Unsal A, Ayranci U, Arslan G. Prevalence of disordered eating and its impact on quality of life among a group of college students in a province of west Turkey. Salud Pública de México. 2010;52:190-8.
- de Matos AP, Rodrigues PRM, Fonseca LB, Ferreira MG, Muraro AP. Prevalence of disordered eating behaviors and associated factors in Brazilian university students. Nutrition and Health. 2020;27(2):231-41.
- Mancine RP, Gusfa DW, Moshrefi A, Kennedy SF. Prevalence of disordered eating in athletes categorized by emphasis on leanness and activity type – a systematic review. Journal of Eating Disorders. 2020;8(1):47.
- Tribole ER, Elyse. Intuitive Eating: @ElyseResch; 2022 [Available from: https://www.intuitiveeating.org/about-us/.