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 contemplation and subjected to long periods of fasting, prayer and meditation. Many of these women claimed and were claimed to have visions revealed by God or saints. Due to the visions and their so ‘level of carnal control’, these women were considered holy, and many came to them for spiritual support.
These religious fasting women are recognized in history records as one of the first annals of anorexia. Their condition is denoted anorexia mirabilis, a Latin term that means loss of appetite by miraculous inspiration (Hepworth, 1999). Today, many experts theorize that the visions described by those fasting women are most likely explained by hallucinations owed to critical levels of starvation and dehydration. The fasting ladies inspired a beauty archetype propagated by Christian affiliations: a model of a white, low-appetite, thin, modestly dressed, religious, discreet, self-disciplined woman (Arizmendi, 2020). With the expansion of Protestantism, this ideal, which was already rooted in many Catholic territories, spread throughout the world. Concurrently, the economic opportunity represented by the black slave trade, triggered the advocacy for the white thin female ideal in arts, literature and fashion. Such white ideal was contrasted with the imaginary that curves of black female bodies denoted gluttony, sexual decontrol, and sinful temptation[3]. In fact, the transformation of pictorial art between the 17th and 19th centuries denoted the metamorphosis of female beauty canons: along time, instead of portraying either black or white women as protagonists of a painting, new works transitioned to depict a woman of white ideal beauty as a central figure, and, in the background, other black women in contemplation (Strings, 2019).
Certain historical records date from contemporary forms of white Christian proselytism led by men and devoted to telling white women how to 'eat for God'. For example, there are records of indications to eat moderate amounts of dairy, nuts, fruits and vegetables with the specific purpose of ‘preventing excess flesh’. Subsequently, it was women themselves who would spread the voice on proselytist food indications in their communities (Strings, 2019).
The ideal of slender women was quickly disseminated in North America through the British influences. By then, and even today, this ideal served two purposes: on the one hand, to diminish black women, by association of blackness with fatness, and fatness with savagery and inferiority. On the other hand, to discipline white women (Strings, 2019). The artistic, philosophical and later-on, fashion veneration of self-discipline and the appetite control as a form of beauty is not really modern. It has its roots in Platon’s philosophy that regarded the body as a prison of the immortal soul and in derived Western interpretations that spawned the body/mind dichotomy (García Zalazar, 2019), especially female’s body, as a source of mundane, vain, impure desire (Arizmendi, 2020).
The schemes of female discipline, derived from this racialized and racist stereotype, were intertwined with influences from Victorian art and fashion, which was permeated by the panegyric of romantic love, the corset trend, and the industrial revolution. Before textile industrialization, the standard custom was for tailors or people to make tailor-made clothing. In contrast, after industrialization, pattern design for mass textile production became the norm (Arizmendi, 2020). Clothing sizes standardization was obviously influenced by the canons of what was considered an average, normative, acceptable body. In the light of these precedents, it is curious to re-think of what we consider "normal" nowadays. Going a few steps back in history, puts us in a new perspective with some distance from our current context. That distance provides space enough to introduce some questions. For example: Why do we think that it is our body that should fit a textile garment and not the other way around? Why do many of us feel wrong when our bodies do not fit the clothes from a commercial store? What is in a "normal body"? Does it exist? Who benefits from what we consider normal or beautiful? May it be possible that we have already been busy in bodies modification for that many centuries that we now find ourselves strangers, alien inhabitants of bodies we do not know, detached from our natural diverse physiognomies, our hunger and intuitive knowledge?
5. Fatness and race as a social construct
The evolution of the pseudoscience of race and fatphobia, and its association with changing immigration and political interests is striking. At different historical moments, not even distant in between, very same human groups were called white, then black, then white again, then fat. Before the mass Irish migration to North America, Irish were referred to as 'white'. Then, along the 18th-century, they appear listed in literature as 'black' or 'hybrid'; then as 'fat'; and then, after their integration, as 'white' again. A similar phenomenon occurred with Jewish and Polish immigrants in North America (Strings, 2020). These paradoxes confirm that for the most part, human classification by phenotype and size obeys to constructs lacking rigorous scientific foundation and shaped by economic and political interests. They also confirm that, from its origins, fatphobia is structurally linked to racism and is not rooted in genuine health concerns.
Some of the groups categorized by the literature as 'fat', propense to fatness, or with higher risk of non-communicable diseases (NCDs) associated to weight excess, are precisely groups that have historically experienced socio-economic exclusion. Many of these groups live in environments technically recognized as 'obesogenic' or 'food deserts'. There, due to various market, industrial, and policy dynamics, nutritionally dense foods (e.g., unprocessed foods, fruits, vegetables, legumes) are scarce and expensive, whereas sugary and ultra-processed foods are accessible. Food desserts often occur in marginal areas, with limited access to health care and health instruction, with high levels of insecurity and lack of safe places to practice physical activity. In addition, individuals from these communities tend to experience chronic multicausal stress. Thus, it is not surprising that groups that have been historically marginalized, including black communities and ethnic minorities are unfairly labeled ‘fat’, ‘ill’, or ‘at higher risk of’ lifestyle related NCDs. Multiple studies from the late 20th century conclude that African American populations are more prone than white to diabetes, cardiovascular disease, and NCDs traditionally related to weight excess. These inferences are based on association, but it is important to understand that association is not always causal. Studies’ results could have just shown a higher prevalence amid black communities, but such prevalence might be caused by the historically shortened access to healthy eating and environments and not owing to being black (Smith, 2021; Strings, 2019).
For decades, black people were merely assumed to be ‘more prone’ to diverse diseases. Today, in acknowledgement of the multidimensionality of health determinants, science is starting to question these inferences, which have contributed to preserve human categorization by color and shape, a practice dating from the 16th century with race pseudoscience. More and more, science spokespeople are rising to point out that, regardless of color or ethnicity, any person who is forced to live in an environment of exclusion, stress, scarce access to adequate food, housing, safe surroundings for physical activity, and health attention and instruction, is more likely to develop excess fatty tissue, metabolic, endocrine, neurologic dysregulations, and related diseases.
6. The 'Diet Culture' as violence against women and pervasive violence
History reveals that the grassroots of 'Diet Culture' come from colonial, slaver, racist, fatphobic, patriarchal paradigms. While today ‘Diet Culture’ affects us all, it started from a fixation on the control of female bodies. Throughout history, patriarchy has defined and controlled what women can do, and shaped women’s aspirations, defining what is acceptable or desirable. Patriarchalism has thus determined women’s lifestyle, modes of expression and participation, looks, sexuality, reproduction, education. Patriarchalism has said: “Are you a woman and want to study? We will tell you how much you can study!” “Do you want to vote and participate in public life? You cannot have a voice!” “Do you want to access land or property, acquire or manage your own assets and finance? You need a man to sign!” “Do you want to eat to satiety? It is not well regarded for you to eat a lot! It is not possible for you to eat as much you need or want without feeling guilty, without having others criticizing you over gluttony, indiscipline, or fatness!”. “It is not right for women to eat like men; to eat more than what keeps them looking thin, modest, discreet, self-controlled, normal or beautiful according to current standards... It is not valid for women to connect with their hunger and satiety; to inhabit their bodies, to feel them as theirs, to decide about it, to discover their legitimate and not imposed tastes and shape of their bodies…”.
These sentences amount to no less than violations of fundamental rights! Violation of women’s right to food, to health, to sexual, reproductive, to civil, political, economic, social and cultural rights... Violations of rights inherent to human dignity! The narrow parameters that define female aesthetics are intrinsically related to the very origins of absurd ordinances to freedom of expression such as: “It is not of a lady to laugh loudly”, “...to raise the voice”, “…to express one’s opinion in public”, “...to contradict”, “...to show the teeth when laughing” or “...to show too much skin”.
Pioneers and leading figures in the field of diets, fitness, the cosmetics, fashion firms and fashion magazines are predominantly men. As an illustration, many of the most renowned diets bear the last name of a man (i.e., Atkins, Duncan, etc.). Current stereotype-making is not as different as that from the Renaissance, the Victorian era, the expansion of Christianity, and the industrial revolution, when it was mainly men who decided how women should look, eat, dress, and behave like (Arizmendi, 2020).
Furthermore, the contrast between the predominant standards of feminine and masculine beauty -in cinema, media, magazines, catwalks, and advertising- is striking. The mainstream female archetype is that of predominantly Caucasian features, extreme thinness or, alternatively, highly toned bodies, with very low-fat percentages, voluptuous breasts and buttocks that contrast with the slimness of waist and oftentimes limbs. Such a form, of course, is attained not only by an army of elite personal trainers, dietitians, chefs, stylists, image managers, health specialists, and estheticians. It is often achieved, reinforced, and maintained through an array of unnatural methods, from makeup, lights, digital retouching, cosmetic massages, injections, infiltrations, pills, aesthetic surgeries, lipoaspiration, and tonifying interventions prior a photo shoot or catwalk.
Such a feminine beauty prototype is fundamentally debilitating: very few women can get the looks without undergoing fasting or low-calorie diets that do not meet the physiological energy and nutrient requirements for an active healthy life. In fact, it is well known that days or weeks before a photo session or a fashion show, many models undergo severe fasts or diets that weaken them to the point of requiring drip interventions and hospitalizations so as not to faint in the middle of the event. There are heartbreaking testimonies, among them those of Kristie Clements, former editor of Vogue Australia magazine, who narrates situations in which certain models arrive at a photo shoot to the point of not being able to move autonomously. The set staff had to move them and help them pose! (Wintour, 2013). Despite everything, these women appear in the ultimate product with silky looking skin, shiny, soft hair, toned bodies, and enviable nails. Logically, at such a level of malnutrition it is not naturally possible to get that look. Such appearance is not attainable for most humankind, unless having access to a militia of costly diet, fitness, medical, marketing, fashion professionals that carefully safeguard it. In contrast, while that of men is also an artificial, arbitrary archetype, and while men also suffer from media bombardment and pressure over physical appearance, the publicized male figure is usually that of a strong, muscular, exercised, ‘well-nourished’ man and not one of a wasted individual, powerless to operate autonomously. Why the difference? As explained above, this contrast, this flagrant promotion of beauty in feminine weakness is not fortuitous: it has positioned itself over time through often unperceived yet strong roots in colonialism, slavery, racism, and patriarchy. Those roots were strengthened with old ideals of chivalry, the Victorian era and romantic love (Arizmendi, 2020).
Those roots are also reflected in the frequency and ease with which, society in general -including men and women- thinks of and talks about women’s bodies. In multiple scenarios, the first thing said about a woman -regardless of her role, profession, aptitudes, or preferences- concerns her physical appearance. Opinions on woman’s outfit, body, hairstyle, makeup, weight changes, that precede any remark on her inner qualities or social roles are pervasive, and society seems to be accustomed, to naturalize, and even foster them. Such comments are not as frequent for men. We repeatedly find comments on social media regarding the look or body changes of women. A few months ago, I read, with great horror, a critic about the massive reaction of viewers to an Instagram image that compared the current appearance of an actor’s wife to her looks twenty years ago. Paradoxically, in both pictures she appeared with her husband. Still, whilst negative comments on her were massive, the opinions regarding her husband’s changes were almost nil. Days later, I was with some family members watching a joint concert of two renowned artists, one male, one female. One of the persons in the room exclaimed: “How fat she has gotten!” - Angry, I replied: “She is a singer! We look up to her for her musical talent, not for her size or appearance! Besides, she started her career very young, and obviously her body would change…Why do we refer to her transformation without even repairing on the male singer who duets with her?” (Who, by the way, just as her, also got older and heavier over the years).
The 'Diet Culture' is a form of control that goes very, very unnoticed, precisely because it is widespread; because its beliefs run from the media to government and health policies, to the intimacy of our thoughts. Although it derives from patriarchal control initially aimed at female bodies and lifestyles, in the end, it exerts violence and control over persons of every gender, skin color, size, and age. As the sociologist Sabrina Strings (2020) states, thinness fascination developed as a form of exclusion towards black bodies, generating at the same time a system of discipline for white. Subsequently, through the effects of industrialization and globalization, this system of moralization, guilt, discipline, and discrimination spread to all spheres of society. Undeniably, as with other types of discrimination, due to intersectionality, the impacts of 'Diet Culture' and fatphobia are disproportionate on women. This is because women, as a group, are more frequently and more intensely affected by discrimination of different grounds.
The 'Diet Culture' exerts control over our resources: It controls the use of personal time. For example, time spent buying food, counting calories and nutrients, or taking care of the looks. It controls our use of mental energy, our self-concept, sexuality, interpersonal relationships, and economy. For instance, the amount of resources invested in special foods, slimming programs, surgeries, cosmetic treatments and clothing that many cannot afford. Therefore, the ‘Diet’ system is not only a racist, patriarchal fatphobic ideology, but even a classist one.
The Declaration on the Elimination of Violence against Women (UN, 1993) defines violence against women (VAW) as "any act of violence that results in, or is likely to result in, physical, sexual or psychological harm or suffering to women, as well as threats of such acts, coercion or arbitrary deprivation of liberty, whether occurring in public or private life." As reported by Arizmendi (2020), in the light of this definition, 'Diet Culture' is a form of VAW that affects our whole society because: (1) it inflicts physical harm, as less than 5% of dieters get to maintain the lost weight off. Weight fluctuation is the most probable outcome after a diet. This weight cycling causes physical, metabolic, and endocrine damages that increase the risk of death from various causes and ultimately make it increasingly difficult to lose weight every time a new restriction starts over. (2) The endocrine disruptions might also cause sexual and reproductive harm. Furthermore, weight stigma and fatphobia permeate and often coerce interpersonal and sexual relationships. (3) It causes psychological harm and coercion: the compulsion and guilt that arise from 'breaking the diet’ after a period of nutritional and psychologic restriction, reinforce the ‘diet’ idea "I cannot control myself”and “I cannot trust myself". The cycles restraint-compulsion-guilt, as well as the stereotypes that promote fatphobia, affect self-concept, generate deep psychological suffering and ultimately coerce freedom. Moreover, dieting is the number one first risk factor for developing an eating disorder (ED) (Arizmendi, 2020).
EDs are a public health problem[4]: they affect at least 9% of the world’s population -although it is worth noting the significant proportion of cases that remain undiagnosed and unreported- (Arcelus, et al., 2011). In Mexico, for example, in the last 9 years the incidence of solely anorexia and bulimia has increased by 300% (Arizmendi, 2020). In addition, EDs are the second most-deadly-mental-illness after opioid overdose (Arcelus, et al., 2011), directly causing one death every 52 minutes (Deloitte Access Economics, 2020). Anyone of any gender, size, and age is exposed to the social determinants of ED and might develop one or more ED. Although the EDs global prevalence is considerably higher in women than in men, and although, as a group, women report greater body dissatisfaction and an earlier start to weight control practices[5], it should be noted that men also tend to consult less often, so they are at a higher probability of underreport as a group.
Precisely because of the media publicized association health-thinness, health-aesthetics and aesthetics-thinness, and the massive objectification of female bodies, nutrition services have progressively feminized. Dietetic consultations are frequently run and attended by women and a large part of the patients consult predominantly motivated by an aesthetic concern rather than health issue (Olivares, 2021). Feminization of nutrition services leads to collective suffering, it reinforces patriarchal canons of control over female bodies, marginalizes men and people with diverse gender orientation from dietetic advice, invisibilizes the struggle of non-feminine bodies with EDs, risky behaviors, and self-concept affected by weight stigma and fatphobia in diverse settings (labor, educational, health).
Health professionals, especially nutrition experts, are not only more prone to assimilating, recreating and spreading health/weight bias - because we have been educated both professionally and informally in the weight-centered paradigm -. In addition, we carry a strong social, media and academic expectation that we embody not only what we preach, but also a normative body, and better yet, the type of body that is promoted in mass media as a 'fit' body type. Personally, I struggled for more than 20 years with diverse EDs, 10 of which I dealt with the shame and guilt of hiding these behaviors while studying and counseling on healthy living. I hid this 'shadow' because I felt a fraud, a double-standards-professional, lecturing what I couldn’t apply, but also terrified of letting go of all my risky behaviors due to the fear of residing a body that would not allow me for credibility and success in my career. After more than two decades feeling alone hiding secrets, shifting from one risk behavior to another, struggling with chronic fatigue, forgetfulness, digestive and endocrine disruptions owing to malnutrition, during my International Certificate course in Nutrition Psychology I was surprised to learn about the high ED prevalence amongst healthcare professionals. Recent studies reveal that healthcare personnel, particularly dietitians, are at higher risk of EDs and risky behaviors precisely because of the fear of rejection and lack of credibility if failing to get and keep a look that symbolizes the diet speeches we are taught (Beech, 2020; Drummond & Hare, 2021; Ekern, 2021; Sabogal, 2021).
Today, I work with the enormous enthusiasm to see that more and more healthcare professionals from diverse areas, more scientists, policymakers, media professionals, a growing number of health and nutrition patients, and a rising share of civil society, are producing and disseminating rigorous evidence which supports that: (i) body diversity is natural; (ii) health or illness might occur at any size; hence, we must promote healthy habits and healthy environments accessible for every person, of any shape, size, color, gender, age; (iii) the effects of weight stigma are even more dangerous - at the health, social, and economic level - than the weight excess implications.
7. Takeaways: what can we do?
We have been raised with the ‘diet’ imaginaries for more than 150 years. We have had the same system for long and we live in a moment of high development of nutrition, genomics, biology, medicine, and sports sciences. Nevertheless, we have not found yet the perfect food program, but we do know, with plenty of conclusive evidence, that 95% of slimming diets not only fail to provide for the goal weight in the mid and long run, but they also cause grave physical and mental harm. Why aren’t our sophisticated science approaches working? Largely because they do not recognize something already evident: that human bodies, even within the same family and ethnic group, are naturally diverse! Even if we eat and exercise exactly the same way than someone else, we will never get the exact same look! We cannot even aim at having the same microbiota composition that anyone’s, and much of our physical, mental health and our complexion depends on it! So, plurality is the norm of humankind and nature, and disregarding it is far away from a health promotion approach. In fact, in many regards, diversity implies richness and opportunity.
We may have a better health system, better public policies, better communications and social networks, all respectful of human rights; better human relations, better self-concept if we understand health, food and beauty from a diversity perspective. A person of any size can adopt healthy habits, including healthy eating behaviors and an active life. Not necessarily, balanced food habits and an active life will lead us all to a slender body. Nonetheless, they will surely help us to impro our physical and mental outcomes. Therefore, means and safe, stigma-free environments to develop healthy habits should be accessible to everyone, to support overall health, wellbeing, development and equal opportunities, leaving no one behind.
In this line, we can all contribute to a more inclusive, freer system and actively combat the violence generated by the 'Diet Culture'. How? Recognizing and making an inventory of our own biases as a first step (Sabogal, 2021). Doing so requires reading, hearing, educating ourselves on the subject, diversifying, and consciously selecting the information we consume. In this way, we acquire tools that serve us both to personally live with more freedom and to endorse more and more inclusive behaviors. Such tools allow us to question, with arguments, the scenarios in which food and behaviors around food or weight are moralized, or where thinness and aesthetics are approached as equivalents of health. Tools acquired through education and reliable information allow us to open conversations around these subjects with family, colleagues, friends, to listen with attention, curiosity and compassion to people with diverse bodies and diverse positions. Above all, they help us take the conscious decision to give up commenting about other bodies or comparing bodies; even comparing ours in the most intimate intimacy, that of inner conversations and battles in our own mind.
Written by Carolina Mejía Toro
Edited by Noemi Nardi and Nicolò Palmieri
Pictures courtesy of: Diagram "Diet Culture", by Carolina Mejía - elaborated on
January 26, 2022; "Diet Culture is sneaky" - a graphic made and shared
by the RDN Kate Scarlata, on October 2020, retrieved from:
https://blog.katescarlata.com/2020/10/13/is-the-health-at-every-size-haes-
approach-really-healthy/
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check our Instagram/YouTube/Podcast/Linkedin/Facebook/TikTok web pages.
[1] A metanalysis published in 2013 that reviewed the results of different weight loss programs reported in the literature, found that after the start of the lifestyle interventions, weight-loss is maximum at 6-12 months and then, regardless of the degree of initial weight loss, most weight is regained over a 2-year period. Over a 5-year period most people reach the body weight they had before the procedure. (National Health and Medical Research Council, 2013).
[2] Recent meta-analyses indicate that social isolation is an independent indicator of morbidity and mortality from all causes of cardiovascular disease and stroke. Social isolation is proven to be more dangerous than excess weight, even when controlling the variables of age, socioeconomic level, and initial health status. Depression is another independent risk factor for cardiovascular diseases, above having a high BMI (Holt-Lunstad, Smith & Layton, 2010; Holt-Lunstad et al., 2015; Valtorta et al., 2016). Stress (including stress generated by weight discrimination) triggers psycho-neuro-endocrine responses that increase the tendency to accumulate body fat and the risk to develop diabetes, metabolic syndrome and cardiovascular disease (González-Díaz et al., 2017).
[3] The controversial and devastating story of Sarah Baartman’s (also called the 'Venus Hottentot'), is a reference in this historical context. Sarah, an African slave, native Joi-Joi, of the Khoikhoi ethnic group, was bought by William Dunlop, a British doctor who took her to England in the early 19th century. Dunlop exhibited Sarah in his circus as a rarity he regarded and presented as a prototype of black beauty. By then, many English had never seen a black person before, and Dunlop presented Sarah’s curvaceous body as a hypersexualized femineity, associated with lasciviousness and sinful desires. That is, an immoral femineity, inferior to the imaginary of virtuous white beautiful women. At the circus, people would not only watch Sarah, but for an extra fee, viewers could touch her glutes. The show drew much criticism in London and was eventually banned, as it took place in the context of the debate on the abolition of slavery. After years of abuse as a circus exhibit, Sarah was taken to Paris, where she became a subject to scientific speculation and prostitution. In 1815, five years after the exile from her homeland, Sarah died, sick, alcoholic, and abandoned at the young age of 25. A few hours after her death, Sarah’s body was dissected for scientific study. Her genitals, brain and skeleton were exhibited at the Musée de l’Homme in Paris and remained on public display for over 160 years. In 1994, Nelson Mandela requested the Sarah’s body repatriation, but only in 2002, after much debate and various legal obstacles, her remains were returned (El País, 2002; Frith, 2009; Strings, 2019; Villar-Pérez, 2017).
[4] A systematic review published in 2019, on the global prevalence of eating disorders (TCA) between 2000-2018, showed that amid 94 studies with an accurate diagnosis of EDs, the weighted averages (ranges) of lifetime ED incidence were 8.4% (3.3-18.6%) for women and 2.2% (0.8-6.5%) for men. Recent studies confirm that EDs are very common worldwide, especially among women. The weighted average prevalence of EDs during the study period increased from 3.5% between 2000-2006 to 7.8% for the period 2013-2018. Such results prove that this is a public health challenge (Galmiche, Déchelotte, Lambert, & Tavalacci, 2019), as well as a challenge for health practitioner, governments, and policy makers. [5] A recent survey conducted in the United States -the country with the most complete figures on ED- indicates that 70% of women and 45% of men, report having felt discontent with their bodies (Arizmendi, 2020). In addition, among women, the average age of onset of a diet or form of weight control restriction is 9 years; in men, the average age is 15 years (Arizmendi, 2020). Moreover, 19.1 per cent of adolescent girls and 7.6 per cent of adolescent boys, fast for 24 hours or more; 12.6 per cent of adolescent girls and 5.5 per cent of male boys use diet pills, powders or fluids; and 7.8 per cent of adolescent girls and 2.9 per cent of male boys vomit or take laxatives in order to lose weight or avoid weight gain (The National Center on Addiction and Substance Abuse (CASA) at Columbia University, 2003).
References
Flegal, K. M., Kit, B. K., Orpana, H., & Graubard , B. I. (2013). Association of all-cause mortality with overweight and obesity using standard body mass index categories: a systematic review and meta-analysis. JAMA, 309, 71-82.
Ahima, R. S., & Lazar, M. A. (2013). Physiology. The health risk of obesity--better metrics imperative. Science, 341(6148), 856-858. doi:10.1126/science.1241244
Arcelus, J., Mitchell, A. J., Wales, J., & Nielsen, S. (2011). Mortality Rates in Patients With Anorexia Nervosa and Other Eating Disorders A Meta-analysis of 36 Studies. Arch Gen Psychiatry., 68(7). doi:10.1001/archgenpsychiatry.2011.74
Arizmendi, A. (2020, November 30). Las dietas para adelgazar como forma de violencia [Weight loss diets as a form of violence]. Mexico D.F., Mexico. Retrieved from https://www.dequetienehambretuvida.com/
Bacon, L., & Aphramor, L. (2011). Weight Science: Evaluating the Evidence for a Paradigm Shift. Nutrition Journal, 10(9). doi:https://doi.org/10.1186/1475-2891-10-9
Beech, K. (2020). More health care workers are suffering from eating disorders amid pandemic. The Denver Channel. Retrieved from https://www.thedenverchannel.com/news/national/more-health-care-workers-are-suffering-from-eating-disorders-amid-pandemic
Chastain, R. (2021). Recognizing and Resisting Diet Culture. Obtenido de National Eating Disorders Association: https://www.nationaleatingdisorders.org/blog/recognizing-and-resisting-diet-culture
Daryanani, A. (2021). What is Diet Culture? Retreieved from UCSD: https://recreation.ucsd.edu/2021/01/diet-culture-social-media/
Deloitte Access Economics. (2020). The Social and Economic Cost of Eating Disorders in the United States of America: A Report for the Strategic Training Initiative for the Prevention of Eating Disorders and the Academy for Eating Disorders. Harvard T.H. Chan School of Public Health. Retreieved Dece,ber 6, 2021 from https://www.hsph.harvard.edu/striped/report-economic-costs-of-eating-disorders/
Diaz, V. A., Mainous, A. G., & Everett, C. J. (2005). The association between weight fluctuation and mortality: Results from a population-based cohort study. Journal of Community Health, 30(3), 153–165
Diversi, T. M., Hughes, R., & Burke, K. J. (2016). The prevalence and practice impact of weight bias amongst Australian dietitians. Obesity Science & Practice, 456-465
Drummond, D., & Hare, S. (2021). Dietitians and eating disorders: an international issue. Can J Diet Pract Res, 73(2), 86-90. doi:10.3148/73.2.2012.86.
Ekern, B. (2021). Healthcare Workers Face a Higher Risk of Disordered Eating During the Pandemic. Retreieved December 6, 2021 from Eating Disorder Hope: https://www.eatingdisorderhope.com/blog/healthcare-workers-face-higher-risk-disordered-eating-during-pandemic-2
El País. (2002). La 'Venus hotentote' vuelve a Sudáfrica tras permanecer dos siglos en Europa. El País. Retreieved December 6, 2021 from https://elpais.com/sociedad/2002/05/03/actualidad/1020376801_850215.html
Fildes, A., Charlton, J., Rudisill, C., Littlejohns, P., Prevost, T., & Gulliford, M. C. (2015). Probability of an Obese Person Attaining Normal Body Weight: Cohort Study Using Electronic Health Records. American Journal of Public Health, 105(9), e55-e63
Frith, S. (2009). Searching for Sara Baartman. Johns Hopkins Magazine. Retreieved December 6, 2021 from https://pages.jh.edu/jhumag/0609web/sara.html
Galler, J., & Galler Rabinowitz, D. (2014). The Intergenerational Effects of Early Adversity. Prog Mol Biol Transl Sci., 128, 177-198. Retrieved 17 de November, 2021 from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6310421/
Galmiche, M., Déchelotte, P., Lambert, G., & Tavalacci, M. P. (2019). Prevalence of eating disorders over the 2000–2018 period: a systematic literature review. The American Journal of Clinical Nutrition, 109(5), 1402–1413. doi:https://doi.org/10.1093/ajcn/nqy342
García Zalazar, M. B. (April de 2019). Rol del cuerpo en Platón, una perspectiva foucaultiana [Role of the body in Plato, a Foucaultian perspective]. ACHERONTA: Revista de Investigaciones en Filosofía [ACHERONTA: Revista de Investigaciones en Filosofía], 25-43. doi:ISSN 2344-9934
Goinvo. (2021). Determinants of Health: Health is more than medical care. Retrieved from Goivo: https://goinvo.com/vision/determinants-of-health/
Golden, N. H., Schneider, M., & Wood, C. (Pediatrics). Preventing Obesity and Eating Disorders in Adolescents. 2016. doi:doi:10.1542/peds.2016-1649
González-Díaz, S. N., Arias-Cruz, A., Elizondo-Villarreal, B., & Monge-Ortega, O. P. (2017). Psychoneuroimmunoendocrinology: clinical implications. World Allergy Organization Journal, 10(19), 1-1
Gould, S. J. (1996). The Mismeasure of Man. Berlin: W W Norton & Company.
Grodstein, F., Levine, R., Spencer, T., Colditz, G., & 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. Retreived September 1, 2021
Hepworth, J. (1999). The social construction of anorexia nervosa. SAGE. pp. 23 25). SAGE Publications.
Holt-Lunstad, J., Smith, T. B., Baker, M., Harris, T., & Stephenson, D. (2015). Loneliness and social isolation as risk factors for mortality: A meta-analytic review. Perspectives on Psychological Science, 10, 227–237
Holt-Lunstad, J., Smith, T. B., & Layton, J. B. (2010). Social relationships and mortality risk: A meta-analytic review. PLoS Medicine, 7, e1000316
Hunger, J. M., Smith, J. P., & Tomiyama, A. J. (2020). An Evidence-Based Rationale for Adopting Weight-Inclusive Health Policy. Social Issues and Policy Review, 14(1), 73—107
Kurtz, P. (2004). Can the Sciences Help Us to Make Wise Ethical Judgments? Skeptical Inquirer, 28(5). Retrieved November 17, 2021 from https://skepticalinquirer.org/2004/09/can-the-sciences-help-us-to-make-wise-ethical-judgments/
Lawrence, R. J. (2014). Understanding Environmental Quality Through Quality of Life (QOL) Studies. En Elservier, Reference Module in Earth Systems and Environmental Sciences (Geneva). Elsevier.
Martorel, R., & Zongrone, A. (2012). Intergenerational Influences on Child Growth and Undernutrition. Paediatric and Perinatal Epidemiology, 26(1), 302-14. Retrieved November 17, 2021 from https://www.researchgate.net/publication/230613470_Intergenerational_Influences_on_Child_Growth_and_Undernutrition
Mensinger, Tylka, & Calamari (2018). Mechanisms underlying weight status and healthcare avoidance in women: A study of weight stigma, body-related shame and guilt, andhealthcare stress. Body Image, 25, 139-147
National Health and Medical Research Council. (2013). Clinical practice guidelines for the management of overweight and obesity in adults, adolescents and children in Australia. Obtenido de National Health and Medical Research Council: https://www.nhmrc.gov.au/about-us/publications/clinical-practice-guidelines-management-overweight-and-obesity
NCD Risk Factor Collaboration. (2016). Trends in adult body-mass index in 200 countries from 1975 to 2014: A pooled analysis of 1698 population-based measurement studies with 19.2 million participants. The Lancet, 387(10026), 1377–1396.
Neumark-Sztainer, D., Haines, J., Wall, M., & Eisenberg, M. (2007). Why does dieting predict weight gain in adolescents? Findings from project EAT-II: a 5-year longitudinal study. Journal of the American Dietetic Association, 107(3), 448-455. Retrieved December 9, 2021
Nordqvist, C. (25 de August de 2013). Why BMI is inaccurate and misleading. Medical News Today. Retreieved December 6, 2021 from https://www.medicalnewstoday.com/articles/265215
O'Hara, L., & Taylor, J. (April-June de 2018). What’s Wrong With the ‘War on Obesity?’ A Narrative Review of the Weight-Centered Health Paradigm and Development of the 3C Framework to Build Critical Competency for a Paradigm Shift. SAGE Open, 1-28
ONU. (1993). Declaración sobre la eliminación de la violencia contra la mujer. Obtained from United Nations: https://www.un.org/ga/search/view_doc.asp?symbol=A/RES/48/104&Lang=S
Olivares, J. L. (2021). Hombres y Cultura de Dieta. (P. Sabogal, Entrevistador) Obtenido de https://www.instagram.com/tv/CT5_nBSFQfA/?hl=es
Paris, Aguilar, Piña, & P.A.P. (2014). Cultura y Alimentación. Aspectos fundamentales para una visión cpmprensiva de la alimentación humana. Annals of Anthropology, 48. doi:https;//DOI.org/10.1016/S0185-1225(14)70487-4OPENACCESS
Sabogal, P. (2021, August). El estigma del peso y su implicancia en la salud, equidad e impacto. Bogotá, Bogotá D.C., Colombia.
Piñeyro, M. (2016). La gordofobia como sistema de opresión. En M. Piñeyro, Stop gordofobia (pp. 49-72). Baladre
Puhl, R. M., & Heuer, C. A. (2010). Obesity Stigma: Important Considerations for Public Health. Am J Public Health(100), 1019–1028
Rubino, F., Puhl, R., Cummings, D., Eckel, R., Ryan, D., Mechanick, J., . . . Huang, T. (2020). Joint international consensus statement for ending stigma of obesity. Nature Medicine
Smith, B. (25 de Febrero de 2021). Heart disease and racial disparities: Why heart disease is more common in Black patients and how to prevent it. Retrieved November 15, 2021 from UChicago Medicine: https://www.uchicagomedicine.org/forefront/heart-and-vascular-articles/heart-disease-and-racial-disparities
Strings, S. (2019). Fearing the black body : the racial origins of fat phobia. New York: New York University Press.
Sumithran, P., & Proietto, J. (2013). The defence of body weight: a physiological basis for weight regain after weight loss. Clinical Science, 231–241
Sutin, A. R., Stephan, Y., & Terracciano, A. (2015). Weight Discrimination and Risk of Mortality. Psychological science, 26(11), 1803–1811. https://doi.org/10.1177/0956797615601103
The National Center on Addiction and Substance Abuse (CASA) at Columbia University. (2003). Food for Thought: Substance Abuse and Eating Disorders. New York: The National Center on Addiction and Substance Abuse (CASA) Columbia University.
Tomiyama, A. J., Ahlstrom, B., & Mann, T. (2013). Long-term effects of dieting: Is weight loss related to health? Social and Personality Psychology Compass, 7(12), 861–877
UNESCO. (2001). UNESCO Universal Declaration on Cultural Diversity. Paris: UNESCO.
Valtorta, N. K., Kanaan, M., Gilbody, S., Ronzi, S., & Hanratty, B. (2016). Loneliness and social isolation as risk factors for coronary heart disease and stroke: Systematic review and meta- analysis of longitudinal observational studies. Heart, 102, 1009–1016.
Villar-Pérez, R. (2017). El love-affair de la Venus Hottentote con el mundo del arte. Radio Africa MAG. Retreieved December 6, 2021 from https://www.radioafricamagazine.com/la-venus-hottentote-y-su-love-affair-con-el-mundo-del-arte/
Wintour, A. (5 de July de 2013). Former Vogue editor: The truth about size zero. Retreieved December 6, 2021 from The Guardian: https://www.theguardian.com/fashion/2013/jul/05/vogue-truth-size-zero-kirstie-clements