NUTRITION SERIES: Weight Stigma vs. Nutrition

Hi there folks. Today I wanted to address a piece of our relationship with food and ourselves that we need to be aware of. I don't even think I can get to addressing our fundamental relationships with food, which is a question someone asked me, without starting to address our fundamental relationships with our bodies and environment  and how that relates to our health. Which ultimately absolutely impacts our relationship with food, because of what diet culture tells us about how we should eat because of the body we are in. 

I need everyone to keep an open mind with this concept. We have been fed the same message from the media and our environment for decades about weight… and it's turning out that our weight actually isn't the problem, but the message we are getting about it is (Bacon, 2010; Harrison, 2019).

This post is not to give any answers to something I think that you as an individual can do to help your health. In reality, there is very little we can do to improve our health from a physical activity and nutrition standpoint - only about 10% of our health outcomes are determined by those two factors combined, to be more exact - and only another 20% are determined by other health behaviors (Hood, 2016; Park, 2015). Not to say health doesn't matter, but to say we can only do so much on a personal level - berating ourselves and others with shame and stigma not only doesn't work/makes it worse/contributes to the negative health outcomes, but it's over something fairly arbitrary. That's a total of 70% of our health that's out of our control (Hood et al., 2016; Park et al., 2015). A big difference we make is going to be how we approach it in our communities, and how we approach ourselves.

Genetics, social determinants of health (the social and economic conditions people are raised in), and clinical care contribute significantly more - and while genetics are non-modifiable, we can work to improve these other factors for each other and ourselves, starting with paying attention (Hood et al., 2016; Park et al., 2015). 

That being said - Here's a line you've probably never heard before: Weight stigma has a more negative impact on your health than actual nutrition intake (Harrison, 2019). 

*dramatic silence while your mind is blown* (honestly, mine was too).

Now before anyone freaks out, I'm not saying nutrition doesn't matter at all ever, and I'm only going to say that once today, because it's not the focus. But I am saying all of that shame you carry about your body and making yourself "healthier" is actually way less healthy for you than anything you're eating/not eating (Harrison, 2019). 

It's a whole new world, the truth. We live in a diet culture that wants to keep us trapped and buying their products and their shame thinking that we are the problem when in fact, their mere existence is what's making us unhealthy, on TOP of what they are selling us (diets that make our health worse). 

The fact that weight stigma is linked on its own to increased risk of mental health conditions (disordered eating, emotional distress, negative body image, low self-esteem, and depression), likely comes as no surprise to you (Puhl et al., 2010). Even if it did surprise you - let's be honest, we tend to value physical health over mental health, we don't count mental health as overall health or as impacting our life expectancy (even if we know it logically, we don't have it internalized, sometimes we still pass judgments on mental health subconsciously or take it less seriously). 

I'm going to get to how weight stigma impacts our physical health, but I first want to paint a picture of all of the other factors that impact our physical health. 

Some causes of inflammation - which can then contribute to heart disease, cancer, and type 2 diabetes include lower social class, being divorced or separated from a partner, not having a job, being in financial trouble, having a greater number of negative interactions with other people, having people close to you struggle with their health, and being treated with disrespect or verbally threatened because of your race or weight - and this is coming from a large body of research (Harvard, 2022; Beatty et al., 2014; Vadiveloo et al., 2017; Harrison, 2019)

Bad life experiences and social injustice are like, major risk factors contributing to increased inflammation and chronic disease… diet can't heal social injustice. If it could, well, that'd be great. 

Weight cycling, (which often comes from yo-yo dieting) repeatedly losing and regaining weight when attempting to lose weight, is also a risk factor for chronic inflammation, which, of course, is contributed to BY weight stigma, as it makes the whole human race believe that they must lose weight to not just be "healthy" but to be worthy (Harrison, 2019). When people try to lose weight, 95-98% of the time it results in regaining the same amount and sometimes up to ⅔ extra than the weight they started off with, as I've mentioned before (Harrison, 2019). Not that weight gain is bad, but like, that's not what you signed up for. Intentional weight loss leads to yo-yo dieting, and for the few that it works for (the 3-5%)... many of them are living with disordered eating, if not, chronically thinking about food and exercise in a way that steals happiness and time (Harrison, 2019). I'm talking about intentional weight loss journeys, because as we know, sometimes weight fluctuates or natural weight loss happens for various reasons. 

I said it once a paragraph ago, and I'll say it again: Diet can't heal social injustice. As much as your kale smoothie wants to, it can't. But maybe that's a relief? 

I want to bring something else up. We associate specific body sizes with weight stigma, and specific body sizes with certain health outcomes. The truth here is that weight stigma ALONE is an independent risk factor for loads of physical health outcomes - like diabetes and heart disease - regardless of body size (Hunger et al., 2015). Regardless of actual body size!!!

Two people at the same point on a BMI chart can have totally different physical health risks depending on the amount of weight stigma they've endured and internalized throughout their lives (Harrison, 2019). 

Someone who lives in a smaller body with significant amounts of weight-based self hatred could have a much higher risk for poor health outcomes than someone in a much larger body who's accepted their size and fights back against weight stigma (Harrison 2019; Hunger et al. 2015).

Independent of fat, weight stigma significantly is related to cortisol (stress hormone) levels and high levels of oxidative stress (risk for heart disease and diabetes) (Tomiyama et al., 2014; Liguori et al., 2018). I mean, I'm just naming more and more studies that are driving home the same truth. But where is all of this in the media? The media makes money off of what doesn't work, because people keep coming back for it. When you think that you're unworthy without something (like the body we're told to have) then that's what we're sold on in media outlets, we blame ourselves when it doesn't work, we continue to feel unworthy, and continue to buy into it, and buy the products, until it continues to not work and keeps us in a shame and money-spending cycle! Have you ever done a weight loss program more than once? Have you ever been on the same diet more than once? Have you ever tried multiple different ways to lose weight or change your body? Has it ever lasted? Has it ever made you happy long term? Does it feel like well-spent money? We buy into it and blame ourselves for a failure that isn't ours, we've just been DUPED. It's hard to accept how much life I've lost to it, but I can't keep pretending it's not real and keep buying into it. 

Here is a big point I'm going to drive home today.

A study of 986 participants that were followed for 10 years found weight stigma being a greater predictor for health risks than what they called "poor dietary patterns" (Vadiveloo et al., 2017).

This study showed how weight stigma is an independent risk factor for physiological stress - regardless of BMI, by looking at allostatic load - which is the combined effects of chronic stressors on many systems in the body; in this case the cardiovascular system, the sympathetic and parasympathetic nervous systems, and metabolism (Vadiveloo et al., 2017). Allostatic load is a more robust predictor of chronic disease risk than other markers because it is assessing the whole body rather than individual parts (Vadiveloo et al., 2017; Harrison 2019). The risk of weight stigma was most significant. 

Weight based discrimination is a greater disease risk than what you eat. 

The person shaming you for eating a burger from McDonald's, or giving you a funny look for eating another cookie, or telling you to lose weight, or making a demeaning joke -

Or the doctor who for no reason besides looking at you recommends weight loss, or your aunt/uncle/cousin/brother/sister/dog sitter who gives you diet advice to try and "help," or, you looking in the mirror and changing your clothes because you don't think you can rock the outfit in your body - you/they are causing the harm to you. Even if well-intentioned. 

Isn't that wild? 

Sometimes we are that person, and it can be hard to unlearn those behaviors. But gosh, with some self compassion and forgiveness when we don't always get it right, we've got to get there. This is what contributes to all these diseases we prescribe weight loss to - the actual act of prescribing the weight loss and making the person feel like they need to change something they quite literally can't. It's not just bad practice to continue prescribing something that for decades now we've known doesn't work, it's bad for our physical AND mental health. 

I DON'T MAKE THESE THINGS UP. Like, why WOULD I? I want to help people, and make a difference. I don't want to cause worse health outcomes for anybody. Why would I go through research, dedicate my career path to it, and lie about it? That would be a stupid way to spend my life. I might as well ruin people's health and make a billion dollars a year doing it in some other more lucrative industry if that was the plan.  It's all true. I can give you resources of people who will tell you the same, if you wish. We've been duped by diet culture and weight-stigmatizing society. You can choose to believe it or not, but the science stands. 

One more study for kicks? This one exposed participants to weight stigma by telling them they wouldn't be allowed to participate in a group shopping activity with designer clothes because they weren't the ideal size or shape for them (Himmelstein et al., 2015). When they were exposed to the weight stigma, their cortisol levels (stress hormones), increased (Himmelstein et al., 2015). For participants who already viewed themselves as "heavy" before the experiment, their cortisol levels remained elevated throughout the experiment and well after the incident was over (Himmelstein et al., 2015). Those who saw themselves as an average weight returned to their baseline cortisol levels quickly after exposure to stigma (Himmelstein et al., 2015). 

And you know what? Self-perception didn't line up with actual body size, 50% of those in the "normal" BMI categories had identified themselves as heavy, and a handful of those who identified themselves as average were in the "overweight" and "obese" category (Himmelstein et al., 2015). Body image predicts health, folks (Himmelstein et al., 2015).

I'm going to stop here today. If you need more proof, I'll give you all the resources you need. But I'm going to speak from my heart for a second. 

You know, I keep thinking that I'm an open minded person… but then something comes along that expands it beyond what I knew. It's like, you have a box that is what you believe and the world as you know it, and as more information and experiences come, your box keeps expanding, until you realize you need to not have a box. Then you're proud because you don't have a box, until you realize there are DIMENSIONS. 

The most beautiful thing I learn from others is to keep an open mind. Most things I would just disregard as not relevant, or not believe certain things about years ago (including issues that regarded sexism, fatphobia, racism, LGBTQ+ rights, and mental health) now are just common knowledge to me, I would be mortified at this point in my life to think the way that I used to. And yet there's still always something new I hear that makes me uncomfortable regarding those topics or others sometimes, not because it's untrue, just because it's NEW, it's not what I'm used to hearing. I need to sit with it and think about it, and make a change with my new information. It's not just about health, it's about justice, it's about our futures, our kids' futures, and the quality of life we believe that the people we love deserve to have. Ending stigma starts from within ourselves. 

Alright clearly I haven't written one of my typical blog posts in a while because here I am ranting on about personal growth. Talk to you all next week. 

References 

Bacon, L. (2010). Health At Every Size: The Surprising Truth About Your Weight. Benbella Books.

Beatty, D.L., Matthews, K.A., Bromberger, J.T., Brown, C. (2014, June 11). Everyday Discrimination Prospectively Predicts Inflammation Across 7-Years in Racially Diverse Midlife Women: Study of Women's Health Across the Nation. The Journal of social issues, 70(2), 298–314. https://

doi.org/10.1111/josi.12061

Harrison, C. (2019). Anti-Diet: Reclaim Your Time, Money, Well-Being, and Happiness Through Intuitive Eating. Little, Brown Spark.

Harvard Health Publishing. (2017). Targeting inflammation: A missing link in heart treatments. https://www.health.harvard.edu/heart-health/targeting-inflammation-a-missing-link-in-heart-treatments

Himmelstein, M.S., Incollingo Belsky, A.C., Tomiyama, A.J. (2014, December 17). The weight of stigma: Cortisol reactivity to manipulated weight stigma. Obesity A Research Journal. 23(2), 368-374. https://doi.org/10.1002/oby.20959

Hood, C.M., Gennuso, K.P., Swain, G.R., Catlin, B.B. (2016, February). County Health Rankings: Relationship Between Determinant Factors and Health Outcomes. American Journal of Preventive Medicine, 50(2), 129-135. https://doi.org/10.1016/j.amepre.2015.08.024

Hunger, J. M., Major, B., Blodorn, A., & Miller, C. T. (2015). Weighed down by stigma: How weight-based social identity threat contributes to weight gain and poor health. Social and personality psychology compass, 9(6), 255–268. https://doi.org/10.1111/spc3.12172

Liguori, I., Russo, G., Curcio, F., Bulli, G., Aran, L., Della-Morte, D., Gargiulo, G., Testa, G., Cacciatore, F., Bonaduce, D., & Abete, P. (2018). Oxidative stress, aging, and diseases. Clinical interventions in aging, 13, 757–772. https://doi.org/10.2147/CIA.S158513

Minihane, A. M., Vinoy, S., Russell, W. R., Baka, A., Roche, H. M., Tuohy, K. M., Teeling, J. L., Blaak, E. E., Fenech, M., Vauzour, D., McArdle, H. J., Kremer, B. H., Sterkman, L., Vafeiadou, K., Benedetti, M. M., Williams, C. M., & Calder, P. C. (2015). Low-grade inflammation, diet composition and health: current research evidence and its translation. The British journal of nutrition, 114(7), 999–1012. https://doi.org/10.1017/S0007114515002093

Park, H., Roubal, A.M., Jovaag, A., Gennuso, K.P., Catlin, B.B. (2015, December). Relative Contributions of a Set of Health Factors to Selected Health Outcomes. American Journal of Preventive Medicine, 49(6), 961-969. https://doi.org/10.1016/j.amepre.2015.07.016

Puhl, R. M., & Heuer, C. A. (2010). Obesity stigma: important considerations for public health. American journal of public health, 100(6), 1019–1028. https://doi.org/10.2105/AJPH.2009.159491

Tomiyama, A. J., Epel, E. S., McClatchey, T. M., Poelke, G., Kemeny, M. E., McCoy, S. K., & Daubenmier, J. (2014). Associations of weight stigma with cortisol and oxidative stress independent of adiposity. Health psychology : official journal of the Division of Health Psychology, American Psychological Association, 33(8), 862–867. https://doi.org/10.1037/hea0000107
Vadiveloo, M., Mattei, J. (2017, February). Perceived Weight Discrimination and 10-Year Risk of Allostatic Load Among US Adults. Ann Behav Med, 51(1), 94-104. 10.1007/s12160-016-9831-7

Good body image, good food, all good all around… summer 2021