Diet as a culture and a legacy of violence: hints to understand and break the cycle
Updated: Jan 31, 2022
By Carolina Mejía Toro
Carolina Mejía Toro is a Dietitian Nutritionist studying for the Master's Degree in Human Rights and Multilevel Governance at the University of Padua. With this particularly consistent and interesting article, she contributes to the launch of the new 'EcoViral' segment of our blog! For this remarkable event, we provide you with a very special and broad piece to give you a taste of our authors' competences! The next articles will be much shorter though.
‘EcoVirAl’ is an acronym for the ‘Economic, EnVironmental, and SociAl’ dimensions of sustainable development. Professor Robert Goodland proposed such a categorization in three dimensions in 1995. The European Union adopted it in its definition of sustainable development.
‘EcoVirAl’ will publish blog articles on all those three dimensions. Each week will focus on one of them. The pieces are not fully-fledged scientific ones, but they retain a degree of technicality. The language of the articles is usually English, even if it is possible to publish in Italian too occasionally. In such a case, the editors will provide a translation.
Enjoy your first reading!
Introduction
The purpose of this article is to celebrate diversity, gender equality and to denounce a ubiquitous, systematic type of violence that often goes unperceived: the violence of the 'Diet Culture'.
Personally, the reflection of this topic touches me deeply. I will probably be more exposed than ever in public along the following lines. I am a Dietitian Nutritionist candidate for the Master's in Human Rights and Multilevel Governance. I devote my career to fighting hunger and promoting health, perhaps because I know the feel of hunger. I have worked, shared, and learned with communities afflicted by hunger, poverty, and violence, and I lived hunger myself. I experienced hunger owed to material shortage and self-imposed hunger owed to eating disorders (EDs). Yes! I am a dietitian and still, I struggled with different EDs for over twenty years. And yes, that is more than two-thirds of my life!
At the start of my career, I thought that studying nutrition would be a way to help myself and others out of EDs. Yet, learning the ought to be's of healthy living was not the remedy. On the contrary, for years, I hid the shame of preaching health without being able to win my own battles. I must admit that the awareness of the image expected from nutrition professionals was a heavy load that perpetuated my condition and secrets. For long, I felt trapped, living a double moral, lacking authority to teach others how to take care of themselves. My road towards freedom and building a healthy identity was much lengthier than I imagined at the beginning of the struggles. Its length has a lot to do with the dynamics that this paper is about to unpack.
1. The Diet Culture
The concept 'diet' technically denotes what an individual routinely ingests. However, 'Diet Culture' refers to the most extended imaginary of 'dieting': a set of efforts (physic, economic, social) to attain a slender physique.
UNESCO (2001) defines 'culture' as: "the set of distinctive spiritual, material, intellectual and emotional features of society or a social group, that encompasses, not only art and literature but lifestyles, ways of living together, value systems, traditions, and beliefs". In line with that definition, the belief system around dieting and slenderness is a culture because it produces a scale of social values, an array of goods, services, symbolisms, narratives, lifestyles, and even art.
The 'Diet Culture' scale of values has a central value: thinness. From the optic of this system, thinness amounts to health. Slenderness or 'normal' body size are understood as a precondition to achieve wellbeing, success, and self-esteem. Thinness is interpreted as discipline, self-care, motivation, and responsibility. What hooks us from this 'diet' is its promise to attain health, recognition, affection, self-acceptance, a sense of belonging, and purpose, as all of these are basic needs common to every human (Arizmendi, 2020). Accordingly, the 'Diet Culture' considers having a large body a misfortune (Arizmendi, 2020). It assumes, often a priori, that large bodies are sick and evidence of lacking motivation, discipline, self-care, productive capacity, beauty, and status. Diet Culture relates to a moralization of health that labels fat or ill individuals as lazy, irresponsible, and unreliable. This moralization is particularly violent against those who lack the means to take care of their shape. That logic contradicts consistent evidence that individual behaviors determine health status by only about 36%; that bodyweight fluctuates naturally throughout life; and that most weight and health determinants fall outside the individual spectrum of action (Goinvo, 2021; Lawrence, 2014; National Health and Medical Research Council, 2013).
The 'Diet Culture' is also a culture by virtue of its ability to produce cultural goods and services. It creates, offers, demands, and sells diets, training packages, cosmetic treatments, surgeries, photographic editing, 'diet foods', cosmetics, girdles, videos, magazines, clothes, exercise instruments, passive gymnastics, etc. Naturally, differences in the capacity to acquire them engender social layers that reinforce preexistent exclusions.
A series of distinctive features characterize 'Diet Culture'. First, moralization and polarization of food and food behaviors. Each diet poses a series of 'good' and 'bad' foods. Dieters often use verbs such as "misbehave" or "sin" to refer to overeating or eating the 'wrong' foods. Second, rigid restrictions, be it calories, one or more nutrients, or food groups. Third, a reductionist and super-individualized view of health and nutrition which: (i) considers that bodyweight merely depends on three variables: energy consumption, energy expenditure and willpower; (ii) amounts fatness to illness; (iii) under the premise "who wants, can" places all the responsibility of the weight and health status on the individual (Arizmendi, 2020). Fourth, normalization of guilt and shame if not attaining the expectations of the diet. However, science proves that maintaining diet restrictions and keeping the lost weight off over time is biologically, psychologically, and economically unsustainable. Conclusive evidence shows that: (i) 95% of the individuals who undergo a weight-loss program regain the lost weight within a span of 1 to 5 years (Grodstein, Levine, Spencer, Colditz, & Stampfer, 1996; Neumark-Sztainer, Haines, Wall, & Eisenberg, 2007); (ii) long-term weight loss is not generally sustainable[1] (National Health and Medical Research Council, 2013); (iii) the annual probability for people with BMI above 30 (obesity) to reach and maintain a normal BMI is statistically very low; (iv) weight loss and maintenance is not only determined by the amount of energy consumed and spent but also by endocrine, genomic, genetic, neurological, physiological factors of the individual, social-psychological factors, characteristics of the food available, the mode of food consumption, and the environment (Hunger, Smith, Tomiyama, 2020; Sumithran & Proietto, 2013).
Furthermore, data also reveals that people categorized as overweight and obese can develop healthy lifestyles. People with weight excess that adopt healthy eating, exercise, sleeping, and stress management habits can develop safe biomarkers that lower their morbidity and mortality risks, even if they maintain their body weight and do not slim down. A large body of evidence proves that weight cycling (the result of recurrent dieting) is indeed way more dangerous than excess weight (National Health and Medical Research Council, 2013).
The fifth characteristic of the 'Diet Culture' is prompting behavioral circles. Restrictive behaviors predispose compulsive behaviors; dieters will eventually break the rigid rules of the diet. Breaking diet rules triggers anxiety, which in turn triggers food indulgence. Indulgence calls for guilt, the reinforcement of the diet idea "I cannot control myself", and a new attempt to find 'the right formula' for self-control (Arizmendi, 20202).
Beyond food limitations, dieting also comprises psychological restrictions, as dieters must calculate their social encounters around food. They often isolate themselves from social events to avoid 'temptations'. Dieting demands much of their time, mental and emotional resources to calculate calories, nutrients, recipes, or behaviors[2]. Before this psychological deprivation, the unconscious will inevitably try to compensate.
The sixth feature that distinguishes the 'Body Culture' is a mindset of competence and body dissatisfaction. This mindset is portrayed by the popular 'before & after' images and testimonials, slimming challenges, and normalized body comparison (comparing public figures, comparing oneself with the media's ideals, with surrounding people, or even with oneself in the past).
Finally, Diet Culture's seventh characteristic is that it often goes unnoticed. Diet beliefs are disseminated and reinforced by authority figures, and since we hear them once and again from a very early age, they might look natural, familiar, difficult to spot (Arizmendi, 2020). Without realizing it, we might unconsciously replicate diet messages.
2. Making us believe that it is all about willpower
Diet culture shames those who cannot keep a slim figure, pointing at them as rare cases of lack of motivation. A solid body of data indicates that between four and five years after a low-calorie diet, less than 3 percent of the population retains 100 percent weight reduction; 28% retains only 10% of the initial loss; and between one and two-thirds recover more weight than they initially lost (Hunger, Smith, Tomiyama, 2020; Sumithran & Proietto, 2013). Difficulties in maintaining lost weight exceed determination. Diverse psycho-neuro-endocrine mechanisms favor weight regain after dieting. Calorie restriction activates hypothalamic weight regulation -an evolutionary survival mechanism that prevents the body from losing weight and keeping weight off-; increases stress and cortisol levels; suppresses the hypothalamic-pituitary-thyroid axis, and alters the thyroid hormone levels. Far away from conscious control, these mechanisms increase hunger, reduce satiety, augment fat storage, reduce the metabolic speed to use energy, and increase inflammation (Sumithran, & Proietto, 2013).
Dieting, especially when done recurrently, provokes endocrine, metabolic, genomic, and psychological alterations with medium- and long-term effects. Those effects can even reach the progeny (Galler & Galler Rabinowitz, 2014; Martorel & Zongrone, 2012).
Diet messages do not mention that the brain naturally develops a greater desire for what it perceives restricted. They do not say that weight loss becomes more difficult every time one starts a new restriction because energy expenditure naturally decreases. Neither they warn that weight fluctuation increases cardiovascular morbidity and mortality, chronic inflammation, risk of gallstones, kidney, endometrial, colorectal, lymphohematopoietic cancer, atypical eating disorders; suppresses immune function; and reduces bone density; (Diaz, Mainous, & Everett, 2005; O'Hara, & Taylor, 2018; Tomiyama, Ahlstrom & Mann, 2013).
Moreover, a complex of evidence points demonstrates that health or disease come in different sizes. People classified as overweight and obese grade I (BMI between 25 and 35) exhibit the same average risk for all-cause mortality as people classified in 'adequate weight' (BMI 18.5 - 24). In contrast, people with BMI classified with obesity grades II and III (BMI > 35) -which correspond to less than 6% of the world population-, present the same risk level as underweight individuals (BMI less than 18.5) (NCD Risk Factor Collaboration, 2016). In line with this evidence, one could assert that extra-thin models are just as likely to die as individuals classified with obesity types 2 and 3.
3. Weight-focused health, stigma, diagnostic errors and discrimination
As Daryanani (2021) reports, the "Diet Culture" promotes an ideology that not only equates thinness and diet with health but portrays individuals who devote time and resources to their health, diet and exercise as morally superior. This ideology favors weight stigma and various forms of discrimination. Weight stigma is the social devaluation based on body weight or size. This devaluation arises from the prejudice that people are guilty of their weight and shape. It shares traits with other disease stigmas, i.e., around VIH+, which blames individuals for their condition and regards them as immoral, dirty, or loads to the health and economic system (Puhl & Heuer, 2010; Rubino et al, 2020; Sabogal, 2021).
Weight stigma can result in discrimination (Sabogal, 2021). Recent studies show it is widespread among healthcare personnel, governments, policymakers, and mass media. Weight stigma is manifest in: (i) the idea, without thorough examination, that any person categorized as overweight is ill or about to get ill; (ii) the attribution of every health problem of fat individuals to their weight, along with the interpretation that weight reduction is the best prescribable solution to any health condition when a person exhibits a BMI over 25; (iii) the prejudice that the weight of fat people derives from gluttony, indiscipline, low self-esteem and self-care, so they are guilty of the problems they face (Bacon & Aphramor, 2011; Sabogal, 2021).
Weight stigma preconceptions often lead to diagnostic errors. For instance, when overweight persons consult and the practitioner attributes their health condition to their weight, thus limiting to the prescription of weight loss without ordering every medical test necessary to discard any other possible cause. Gross data reveal that, statistically, health professionals devote less time and health education to people classified with extra weight (Rubino et al., 2020). Consequently, those patients get worse healthcare than patients with normative or thin bodies, who are more likely to get a better examination and diagnosis (Diversi, Hughes, Burke, 2016; Hunger, Smith, Tomiyama, 2020; Mensinger, Tylka, & Calamari, 2018; Puhl, & Heuer, 2010). Weight stigma, therefore, increases the risk of morbidity and mortality of millions of patients who are wrongly diagnosed and treated or who, by fear of judgment, avoid health consultations and end up reaching out when their conditions are advanced and riskier (Rubino et al., 2020). Moreover, the contribution of weight stigma to all-cause mortality is significatively higher than mortality caused by weight excess (Sutin, Stephan & Terracciano, 2015).
The most widely used methodology for body weight classification is the Body Mass Index (BMI). Nevertheless, BMI is a misleading indicator. Numerous health authorities denounce that it lacks a scientific basis and contributes to weight bias and misdiagnosis. They underscore that it consists of a weight-to-height ratio that does not distinguish the percentage of body weight from fat, water, muscle, and bone mass. It does not consider bone density, age, ethnicity, genetics, sex, physical activity, or pre-existence of diseases (Ahima & Lazar, 2013; Nordqvist, 2013). Afro-descendant population tends to have a higher percentage of muscle mass than the Euro or Asian descendants. BMI does not take these differences into account, so many African descents end up classified as overweight. This error contributes to the historical association between fatphobia and racism that will be tackled in the next segment of this article. Second, BMI was developed in the 1830s, not by a nutrition or health expert, but by Quetelet, a Belgian mathematician and statistician, who acknowledged that the measure was arbitrary. Insurers had observed that middle-class, white men with heavier bodies, tended to die younger. Quetelet developed BMI formula to streamline a former weight indicator that the Insurance European sector used at the beginning of the 19th century to calculate the probability of all-cause-mortality of white, middle-class men. Hence, BMI is not representative of diverse populations (Strings, 2019).
Furthermore, in a letter to The Economist, Nick Trefethen, Professor of Numerical Analysis at the Mathematical Institute of Oxford University, explained that the BMI formula leads to confusion and error because, by dividing body weight by the squared height in meters, one would be dividing weight by a lot for those who are short and by little for tall people. Consequently, tall people end up classified as being larger than they really are, whereas short people end up thinking themselves thinner (Nordqvist, 2013).
4. Fatphobia, racism, patriarchy and violence
It is evident that, in the end, the diet belief system amounts to a control system: control of the bodies, the economy, time, leisure, artistic, philosophical and literary expression. Although it preaches so, such a control system is not really anchored in a health concern established on scientific evidence. The diet paradigm disregards the bulk of evidence demonstrating that human bodies, just as in other species, are naturally diverse, even amid people from the same ethnicity or family, or sharing the same dietary pattern and exercise program. In contrast with the 'diet' imaginary, up-to-date conclusive evidence confirms that health or disease might occur at multiple sizes (Sabogal, 2021).
To understand the 'Diet Culture', it is necessary to understand the phenomenon of 'fatphobia'. Fatphobia consists of the rejection to, or fear of bodies considered as 'fat'. Such rejection originates in a bias founded on preconceptions about the implications of inhabiting a fat body. On the ground of this bias, health systems, governments, developers of mainstream beauty standards, the cosmetics, fashion, food, fitness industries, artists, and, consequently, much of society, assume that having a large body is just 'terrible'. They pathologize larger bodies by assuming ‘big’ is a synonym of illness, of great unhappiness, or undesirable personal traits (i.e., irresponsibility, laziness, inconstancy, low self-esteem). Over these unfounded deductions, people labeled as fat are directly or indirectly discriminated, inferiorized, humiliated, treated with condescension or pity, marginalized from opportunities, invisibilized and ridiculed (Pineyro, 2016).
Multiple studies show that weight discrimination is at present even more frequent than racial discrimination (Tomiyama et al, 2018). As in other types of discrimination, weight discrimination worsens in intersectional scenarios. That is, when fat-phobia converges with other bases of discrimination (e.g., gender, nationality, ethnicity, sexual orientation, disability, age, socioeconomic level).
So, if there is a great deal of evidence that dispels weight-centrism, why then does the weight-centric discourse remain so widespread? - It is evident that, in large part, it moves a multimillion-dollar industry of goods and services. However, its ubiquity is not solely due to its economic potential: the exaltation of thinness has robust historical roots dating from the late nineteenth century, intricate with racism, slavery, colonialism, religion and patriarchy.
It is not possible to comprehend the ‘Diet Culture’ paradigm without understanding fatphobia and its origins in racism, the modern expansion of Christianity, and the patriarchal control of female bodies. After the colonization of America and the subsequent, drastic reduction of the indigenous population, a frightening yet powerful economic engine broke out in Europe: The African slave trade. This new economic model paved the path to race pseudoscience, also known as 'scientific racism', mainly spread between the 17th century and the Second World War (strings, 2019).
Using elements of physical anthropology and other disciplines, race pseudoscience proposed the categorization of human populations into physically differentiated races, some superior to others. At the same time, various European artists, catholic and next, protestant leaders, evolved an ideal standard of feminine beauty and virtuosity. Initially, during the Renaissance, in the context of colonialism, various artists represented and recognized various forms of beauty in women of different colors and traits. In these works, the beauty of curved women was admired. However, prompted by the expansion of the transatlantic slave trade, towards the end of the seventeenth century and during the eighteenth century, much of the pictorial, literary and pseudoscientific expressions promoted a model of white female beauty as the archetype of superior beauty. The new archetype required elements to denote the white superiority, and thinness became a key one: since renaissance, Christian creeds revered the virtue of self-control, especially in women. Therefrom, women of little appetite, devoted to religious life or motherhood, started to be portrayed as beauty models. Such model revolved around a virtuous, morally superior type of beauty, depicted as beauty transcending a so thought female attractiveness that summoned the ‘appetites of the flesh’ (sexual and food drive). The emerging aesthetic model of a white, thin, demure woman was thus superimposed over the femininities from other 'races', especially that of black women, whose naturally more-voluptuous bodies began to be regarded as sinful and symbolism of carnal voracity (gluttony, lasciviousness, lust, distancing from God and spirituality) (Strings, 2019).
The pseudoscientific and artistic fascination about defining a superior race, amalgamated with religious paradigms rooted since the Middle Ages. During the Middle Ages, Christians advocated a certain prototype of ideal woman: white European women, engaged in religious co