I received a direct message asking about the role fat plays in causing disease and I figured it was time to address it! The message was as follows:
“Hi, there. I thoroughly enjoy your account after recently discovering you on TikTok. I just watched your Intuitive Eating 101 training and I have a question, granted I think it’s a loaded question and it may be hard to answer on this platform, which is why I’m having a hard time reconciling. I will start by saying I am a physician and I also have been plagued by diet culture and food guilt my whole life, so intuitive eating really makes sense to me. What I’m having a hard time with is the lack of acknowledgement of the known adverse health outcomes associated with much larger bodies and how to talk about that honestly (for me, with patients) and not to perpetuate diet culture and food shame on them. I know you talk a lot about the goal of intuitive eating being to not shrink your body, so if that is the goal of the patient, what next?”
This is such an amazing question and I want to thank the person that reached out and asked it. Whether you are a physician, a medical professional, in the health & wellness field, a coach, a patient, or a client, this is an important question that people on both sides of the aisle seek an answer to.
To start, I’m going to go through the DM and talk about what thoughts arose for me while reading it. But, the first thing I want to mention is that as you go through your intuitive eating journey, there’s going to be a lot of uncomfortable things. We need to harness the curiosity that arises within each one of us because we can only learn by reflecting on the hard questions.
Most registered dietitians are classically trained in a weight-centric approach with a lens through diet culture. We are looking at the education system for registered dietitians and the classes and programs required to sit for the exam. Of course, I am not a physician. But, I have worked with a lot of physicians and a lot of our clients are physicians. The person who submitted this was so courageous in trying to begin to break free from the weight-centric education they were likely exposed to.
With intuitive eating, aspects such as Health at Every Size® (also known as HAES®) and taking a weight-neutral model. Know that it is okay if you have some beliefs rooted in diet culture messaging, your degree and credentials have quite a bit of influence on this. This is a tale as old as time.
I want you to know that this is exactly how I was trained. To any health professionals reading this that can relate, know you are not alone.
So, let’s imagine a scenario. If someone in a larger body went into the doctor’s office and complained of knee pain, someone practicing from a weight-centric approach might ask, “have you tried to lose weight? What have you done to lose weight?” And so on… This happens instead of addressing questions like “when did this pain start? Have you tried anything to help aid the pain, like physical therapy, acupuncture, support braces, or massages? Can you show me the positions that cause feelings of pain?” Immediately assuming the key to alleviating the knee pain of someone in a larger body is an answer made with a lot of judgment and assumption, based on the size of their body.
Let’s move back towards an intuitive eating mindset to think about the scenario. Thinking from this place, if someone says they are experiencing knee pain, we are not going to look at their body and judge anything. We are going to ask a lot of questions—like those listed at the end of the previous paragraph—see what they’ve done and work with them. We are on their team. This is not an authoritative relationship. This is a very important part to address in regard to the initial question because, as a registered dietitian and someone who knows a lot of physicians, a lot of medical training comes from a weight-centric approach. This is a sentiment I hear often from other health professionals. Of course, with the individual who submitted this question, I don’t know their whole story, whatsoever.
Even if this is where I stopped unpacking the DM, this is such useful information to move forward with. But, there is even more that I think we can dive into after reading the submission.
There could also be fears of gaining weight, the fear of “becoming fat,” or preconceived notions about people in larger bodies. A lot of what we do with our clients is unpack the belief systems influencing what you’ve been led to believe about someone that resides in a larger body. Society labels with adjectives like lazy, out of control, and so on. These belong right in diet culture’s classic messaging!
Get really curious about the belief systems about people in larger bodies you have operated from. Think about how the beliefs are untrue. If they were true, everybody in a smaller body would, supposedly, have no issues. Start to create evidence against the beliefs you have about body size. These beliefs have been influenced by society, our parents, our teachers, media, and more.
If you identify any beliefs, remember you are merely human. Humans are plagued by diet culture, it is loud and overwhelming. Get curious and focus on yourself by turning inward. Give yourself grace as you dismantle external diet culture voices plaguing your thoughts. This is very important to being able to work with others from a weight-neutral standpoint.
Lastly, let’s unpack the last part of the direct message:
“What I’m having a hard time with is the lack of acknowledgement of the known adverse health outcomes associated with much larger bodies and how to talk about that honestly (for me, with patients) and not to perpetuate diet culture and food shame on them. I know you talk a lot about the goal of intuitive eating being to not shrink your body, so if that is the goal of the patient, what next?”
I want to pull excerpts from one of my favorite books, Body Respect by Lindo Bacon. Body Respect is a great resource to read to dive further into a weight-neutral approach after reading this blog post. Before jumping into the book, focus on some of the main takeaways from this blog post so far:
Health is not a moral obligation. As a physician, unless a patient (and, this applies to everybody, both the physician and the patient in the scenario) asks about ways to change to better health outcomes, there is not necessarily a need to project diet culture messaging. Remember, weight does not equal health. When you’re working from a weight-centric model, with a focus on weight management and/or loss, losing weight is seen as the “end-all-be-all” for every medical condition and disease. When working from an intuitive eating paradigm, there is no obligation to do anything. But, if they do want to address behaviors to impact their health, think of behavior changes that are uncoupled from body size. We know that weight is not a behavior. So, if weight is not a behavior and weight does not equal health, what are things that can be done to improve health? Look at things like sleep patterns, hydration status, stress management, participation in joyful movement, the foods and drinks we consume (not meant to shine a light on any ways to restrict, but generally). These are all behavior changes that can be worked on with patients/clients that are not focused on changing the size of their body. Remember, these are behaviors to work on only if the client wants to! Coming from a weight-centric mindset, health is a moral obligation. This results in an authoritative relationship. Coming from an intuitive eating mindset, there is no obligation to make any changes.
Now, for Body Respect by Lindo Bacon. I highly recommend this book to medical professionals and anyone who has struggled with society’s standards surrounding body size. It touches on information left out by standard health books as well as the information that is just plain wrong. The information is broken down in a simple, life-changing way.
I want to touch upon two pieces from the book. Bacon breaks down myths surrounding weight and body size. The first myth is that “fatness” leads to decreased longevity. (Note: when using words like “fat” or “fatness,” I am using them without any connotation. A part of making peace with body size is reclaiming the word “fat” and understanding its role as a descriptor. There is no morality tied to it.) When discussing weight and health, even the scientific experts in the U.S. government struggle to separate fact and bias. Or, the bias makes accepting facts that prove them wrong much more difficult to accept. At this point in time, there is a large amount of peer-reviewed research showing that people in the “overweight” category live longer than people in the “normal” category. And, people who are mildly or moderately “obese” live at least as long as those in the “normal” category do. Statisticians at the CDC even found this to be true and published the data in the Journal of American Medical Association. However, the CDC published a disclaimer to state health agencies encouraging those agencies to disregard the data. Another document was published saying that “obesity” can be deadly. Another document stated that “obesity” and “overweight” are critically important health threats to the country. If it sounds outlandish, join the good company of many well-established experts. This is all credited to Lindo Bacon’s Body Respect.
The research modeled really important information. Those in the “overweight” category live longer than people in the “normal” category and people who are mildly or moderately “obese” live at least as long as those in the “normal” category do. Yet, the CDC backtracked against the published evidence. This perpetuates fear mongering. If you are a physician or medical professional, go grab a copy of Body Respect, go read the data, and do the work. See it with your own eyes and start to transition your frame of thinking.
Now for another myth from Body Respect, that fat plays a substantial role in causing disease. Bacon said, in this amazing excerpt: “It is true that many diseases are more commonly found in heavier people. However, that doesn’t mean that the weight itself causes the disease. Much of the evidence on the topic is being based on epidemiological research, which is a type of research that tracks people over time and examines differences between groups. And while many epidemiological research studies have shown that larger people are more likely to develop several diseases, it is important to note that epidemiologic research shows association not causation. Consider the difficulties that arise if we try to assign casualty to epidemiological data… There is a lot of research that shows that bald men have a higher incidence of cardiovascular disease than men with lush heads of hair. So, do we look at that data and conclude that CVD, or cardiovascular disease, is caused by baldness? Or, that hair protects against CVD? No. Examination of other research shows that bald men have higher levels of testosterone and that high levels of testosterone increases risk for CVD. In other words, testosterone is a co-founder that explains that relationship between baldness and CVD. Coming back to the association between weight and disease, there are many traits and behaviors that differ between lighter and heavier people that could explain the increased disease incidence much more readily than fatness.” To summarize—or else I could read you more of the book and turn this blog post a novel when I truly want everyone to grab a copy at some point along your intuitive eating journey—the three co-founders are fitness, discrimination, and dieting & weight cycling. These are the three co-founders that, regardless of the size of someone’s body, are going to have extreme ties to increased disease risk.
Let’s wrap this blog post up, if you made it this far – THANK YOU! If you are someone who has spent years in diet culture, has guilt & shame around food, someone that generally wants to improve their health, know you are in the right place. The majority of people who go on diets typically do it for two reasons. One, to lose weight. Two, to improve their health. But, we know from research that dieting is the number one indicator of weight gain, more than ⅔ of dieters gain back more weight than they originally lost, and that dieting is one of the number one co-founders for increased disease risk.
Take a deep breath. This was a long blog post that covered some pretty intense topics that may have created different emotions for you as you read. That is natural. Write down any emotions that came up while reading this, or give your brain a break and participate in some self care!
If this blog post resonated with you, you can hear more by listening to our podcast episode discussing myths around body size. Click here to tune into the episode! You can listen to our Find Food Freedom podcast on Apple Podcasts, Spotify, and Amazon Music.
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