Health, particularly behavioral health, has become bound up in morality.  The term for this is “healthism” based on a philosophy that everyone is responsible for their health but in a way that makes “healthy behaviors” seem to be more morally superior.  This is particularly a problem when it comes to body size.  There is a feeling that if health is under your control, then that means you must be “choosing” to be obese (as defined by body mass index).  Often people living in larger bodies, then are blamed for not fitting into the “healthy ideal. The problem is that moralizing about health creates weight stigma, which we know leads to discrimination against people of size in many areas of their lives.


Hi it’s Dr. Carolyn Coker Ross this is Episode 52 on Healthism. So, on this episode I’ll be talking about what is morality have to do with health. I’ll also be talking about why is healthism creating more weight stigma or fat shaming and finally why even the covid19 pandemic may cause weight stigma. Stay tuned!

Okay. Healthism, it’s the new way to talk about weight loss. It’s a new way to promote weight stigma as well. So health, particularly behavioral health has always been bound up in morality. When we look back through the centuries, we know that being able to deprive yourself of food and being a part of thin ideal has been equated to being morally superior. So the term for this is really healthism, and it’s based on a philosophy that everyone is responsible for their health, but in a way that makes healthy behaviors seem to be more morally superior.

I just think about it, you know, there’s nobody who really worries about saying that they have had anorexia, uh, because that’s seen as the more appealing of the eating disorders. We also know that even in religion, there is a promotion of the thin ideal, and of course, all throughout advertising. So now it’s been politically incorrect. For some time to create weight stigma or to fat shame people. And instead of doing that, what we’re now doing is saying everybody needs to be healthy.

So healthism, again, based on this philosophy that all your entire health is completely under your control, and if you practice healthy behaviors, then you’re somehow superior to other people. So this is a particular problem when it comes to body size. There’s a feeling that, if health is under your control, and that means you must be choosing to be living in a larger body.

Often people living in larger bodies then are blamed for not fitting into the “healthy ideal”. What size you are, is thought by many to be easy to control and people in larger bodies are stigmatized as being lazy, overindulgent or lacking in self-control. Now, this is, despite the many, many studies that demonstrate the complexity of the problem of size, research has shown conclusively on numerous occasions that diets don’t work and it’s also showing more recently that medical science has been biased in terms of linking health to a number on the scale. The health size association may be more to do with metabolic issues and metabolic fitness than a particular weight. So when I say metabolic fitness, I’m talking about your blood sugar, your cholesterol levels, um, other things like that.

Uh, so that would point to lifestyle as a better measure of health. But however, even here we’re stigmatized, we have stigmatized foods and given such conflicting advice to people about what to eat and what not to eat, that it’s tainted even reasonable nutrition advice. So there’s that whole long list of bad foods that we’re not supposed to eat, and we’re only supposed to eat those good foods. So if you have a piece of chocolate or you eat bread, then you’re not as morally superior. And this has been taken to an extreme. And, um, the, uh, the eating, the disordered eating called orthorexia where people are become obsessed with quote unquote clean eating or eating only the healthy foods. So my friend Julie Duffy Dillon, who’s a noted nutritionist stated in, uh, she stated in a recent blog. And here’s what she says. Most industries that do not provide longterm results fail to make it in the marketplace. The diet industry has alluded this marketing regulator instead, the diet industry has designed diet pills, meal replacements, meal plans, calorie counts, gym memberships, et cetera, that fail for the majority in the longterm. In fact, industry executives at one major weight loss program likened diets to playing the lottery. “If you don’t win, you play again. Maybe you’ll win the second time”.

Okay. So I agree completely with Julie that, um, for some reason, diets have continued to prosper while those who are buying and purchasing these diets are not prospering. The problem is that moralizing about health creates weight stigma, which we know leads to discrimination against people of size in many areas of their lives, including the workplace health care facilities, educational institutions, the media, and in relationships, it can also affect children as young as three years old.

The presence of weight stigma has increased by 66% in the last decade corresponding with the war on obesity. Weight stigma is rarely challenged and it’s felt by some to be necessary and justifiable because of this notion of healthism that living in a larger body is your personal responsibility and that it’s possible to shame someone into losing weight, which we know is not possible. The prevailing emphasis on personal responsibility is a cause of differences in a person’s size have been refuted by science. There are so many determinants of size that have nothing to do with calories in and calories out. Included here is the role that genetics plays in metabolism and biology. And those are things that play a huge role in body weight along with social and economic influences that can promote weight gain. Here are just a few increased availability of and decreased cost of calorie dense foods and drinks and increase in prices of fruits and vegetables.

So, you know, going through the fast food line. Is a lot cheaper than perhaps buying something in the store and cooking at home. As well many people live in what we call food deserts, where they have very poor access to grocery stores or where the stores in their neighborhoods do not carry many of the fresh fruit foods that are health promoting. There may be lack of public transportation in many areas, which can compromise access to desired foods. And there’s a lack of safety and walkability in many neighborhoods. There’s also evidence that certain toxins in our environment can also promote weight gain. Beyond these concepts is the notion of body autonomy, generally considered a human right. Body autonomy means a person has the right to control their own bodies or better said a person has the right to allow their own bodies to be what they are meant to be. This begs the question, so who are we to tell anyone how they should look, what they should eat, and how much they should weigh?

We’ve been led to believe that there’s a solution for being a bigger size or being in a bigger body and that solution, the only solution is to diet. However, studies have shown over and over that diets don’t work. I don’t know how many times I say this a day, a study of in 2007 reported that 30 to 60% of dieters gained all the weight they lost. And then some. As well. Dieters didn’t experience any significant changes in their overall health studies that followed dieters for more than two years, found that 83% gain back more weight than they’d lost. So basically, diets not only do not work, they are a predictor of future weight gain.

In my work with individuals experiencing eating disorders for over 30 years, it is clear that people in larger bodies have often started on the diet roller coaster when they were children. This along with the weight stigma that many experiences led to low self-esteem and has caused them to put their lives on hold, waiting for “the perfect body”. Before they can pursue their dreams of a relationship or changing careers or fill in the blank. It’s time to acknowledge that weight is not a moral issue and that diets will never work in the long run as well. We know that you can be healthy no matter your size. Given this healthism is just code a code word for weight loss and it’s another way for promoting weight stigma and it should not be tolerant.

So I mentioned, I would also be talking about why even the covert 19 pandemic and cause weight stigma and fat shaming. There are people now who are identifying that health consequences from the infection with covert 19 are striking people who are “obese by BMI, measures and have chronic medical conditions like diabetes and hypertension as well as many others”. This again, this link, this linking of obesity or body size to a health consequence is erroneous, and it is not, uh, something that is proven in science and we need to really take that off the table when we start talking about health. And instead put on the table the positive things that people can do to improve their overall health. And we know what those are, you know, body movement of any kind, eating regularly throughout the day, avoiding restricting. You know, these kinds of behaviors are more important than that number on the scale.

For the person living in a larger body recognizing that diets don’t work is really about coming to respect and honor your body. This may be work you have to do no matter what you’ve been told by the medical profession because the medical profession, sadly, my colleagues are the number two purveyor of weight stigma in our culture. Now as a medical doctor myself, I have to admit that for most of my career, at least the first, you know, 15-20 years, I believed all of the research that was done that showed that obesity was linked to numerous health conditions. But however, I have to say that over and over. When I saw my patients struggling so hard to lose weight and then only gaining, uh, all the way they’ve lost and then some. I began to realize pretty quickly that diets were not the solution. And now am very, very clear that the, that focused on, on the number, on the scale and linking that to health issues is not the solution either. So it’s probably true that people with diabetes and other chronic health issues are getting infected more often and having more serious consequences from Covid-19 but it doesn’t necessarily follow that their body size is the reason for that.

There are now many organizations and some physicians and dieticians that promote body neutrality, weight inclusivity. I encourage you to claim your own body autonomy and choose how you want to live and be healthy in the body that you have.

Thank you for listening. I want to remind you to leave a review for our podcasts to help us get the word out. And I also wanted to tell you about the upcoming anchor program, which starts very soon. And the anchor program for those of you who don’t remember, is a 12-week intensive program. It’s a non-diet approach to helping you make peace with food and your body. So it’s, it’s all about removing some of the barriers that you may have developed over time, um, that keep you from being able to make peace with food and your body. So many people struggle with binge-eating, compostable eating , food addiction, and emotional eating, and they, they are not able to find a way to get past those barriers that they’ve had, so that this is what we’re offering. I mentioned before, I’ve turned back the price to 2019 prices in consideration for the many, many people who have had financial stressors or financial worries during this period. And I just wanted to read one of the testimonials from someone from the anchor program who finished the anchor program. And she said, “the anchor program has changed my life for once there is a program that gets to the heart of helping you understand why you’re struggling and teaches you how to change your patterns you spend a lifetime establishing. Previous diets feel superficial and I now see why they failed. The anchor program helped me recognize my true self and for the first time in decades, I’m no longer ashamed of who I am”.

So I hope you will consider, uh, at least taking advantage of the free consult that I offer. And remember, the consult is not for me to promote the anchor program. The free consult is just for you to be able to get any advice that I can offer as an expert in the field about your food and body image issues. And I will put the link to the booking, the consult, and the show notes, the show description, and I look forward to talking with you next week. Thanks again.


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