The first time I was officially introduced to diet culture was through Mayo Clinic’s adolescent pain rehabilitation program. A doctor was giving a presentation on the dangers of dieting; she had worked as an eating disorders specialist for years before she switched to studying chronic pain. She accredited the switch to the fact that an unlikely majority of her patients with eating disorders also had underlying health conditions, such as chronic pain. The overlap was both confusing and fascinating to her. The culprit? Modern diet culture.
While dieting has existed since the Ancient Greeks and appeared in a variety of cultures across the globe, the goal of dieting with the express intent to lose weight is only a modern phenomenon. Not only that, but it’s seeped into every part of our lives. Our humor, beauty standards, morality, medicine, and even views on work ethic, are inextricable from diet culture. It’s created a pervasive system of shame that blames the individual for their weight and accuses them of being lazy for not “fixing” it. By itself, judging someone else on their health is narrow-minded and ableist. Yet, it’s an attitude that many of us approach ourselves with. Society ingrains diet culture so deeply within us from such a young age that the majority of us struggle with body image at some point in our lives. The National Eating Disorders Association (NEDA) states, “By age 3, children have often internalized stereotypes about body size and children as young as 5 start to express concerns about their own weight or shape. For example, studies have found that 40-60% of elementary school girls (ages 6-12) are concerned about their weight or about becoming fat.” Personally, I’ve known too many loved ones in my life who’ve struggled with disordered eating and poor body image, and it’s infuriating because they didn’t need to. It’s all nonsense. Diet culture was built on bad science and bigotry: it’s time we get rid of weight as a metric of health.
To be clear, including healthy foods in your diet and exercising is not a bad thing. Neither is taking a patient’s weight into consideration when assessing their health. Due to my own chronic illnesses, I was severely underweight for the majority of my life. In that instance, it made perfect sense that my doctors tracked my weight because they needed to gain a sense of whether I was eating properly or not. However, that decision was made by considering other aspects of my health. Forming your opinion of someone’s health or deciding on a treatment plan for a medical patient primarily based on their weight is not only inaccurate, but also dangerous. Yet, that’s currently what a majority of doctors do. This practice is primarily due to a staple of modern diet culture; the Body Mass Index (BMI). The BMI is a score calculated by dividing a person’s weight by their height squared, and determines whether a person is considered underweight, healthy, or overweight. I’m sure your family’s physician has talked to you about your own BMI score before. The index is a key part of our medical system. Doctors are trained to use it, despite the fact it wasn’t created to be used as a medical tool at all. According to the article “The History and Faults of the Body Mass Index and Where to Look Next: A Literature Review” published by the National Library of Medicine and written by Rachel Pray and Suzanne Riskin, the BMI originated in the late 1800s from the work of Adolphe Quetelet, a Belgian statistician, mathematician, and astronomer. Not a medical professional. Then in the 1950s, it was used by Louis I. Dublin, statistician and vice president of Metropolitan Life Insurance Company, to create a measurement of “normal” clientele weights for the company, before it was popularized by physiologist Ancel Keys in 1972. None of these three men ever aimed for the BMI to be used as an official medical tool. Keys even admitted that “the best relative weight index is the one that shows the least correlation with body height and the highest correlation with independent measures of body fatness.”
While it’s already clear that the BMI is medically unreliable due to how it was conceived, the way discrimination and bigotry come to play a part is through the sample sizes of Key’s studies. Not a single one of his subjects were women. This means that the measurement which dictates most of our doctor appointments, and often decides whether our health concerns are taken seriously or deemed a symptom of being overweight, may not even be applicable to women’s bodies. Most adult women I know have stories of doctors dismissing their medical symptoms as a result of having a high BMI score, only to later be diagnosed with serious illnesses. By measuring women’s health based on an index that doesn’t accurately represent them, our healthcare system is delaying and even denying vital medical treatment for those assigned female at birth. This practice, however accidental it might be, perpetuates existing systems of misogyny. Receiving inadequate medical care makes it harder to do just about anything, in addition to the fight against job discrimination or street harassment. That’s another reason it pains me to hear my friends and family struggle with body image; we can’t do the patriarchy’s work for them by hating ourselves. You and your body don’t deserve it. Women need our entire health to be considered in medical decisions, not simply our weight, to adequately address our mental and physical health.
However, the BMI didn’t cause modern diet culture’s explosion of popularity; the index only guided it along. In reality, weight loss goals becoming so ingrained in our society was never because of health concerns. It was due to racism. Sabrina Strings — Chancellor’s Fellow, Associate Professor of Sociology at the University of California, and author of Fearing the Black Body: The Racial Origins of Fat Phobia—pinpoints the start of the popularization of dieting around the late 19th century. On an episode of the NPR podcast Short Wave titled “Fat Phobia And Its Racist Past And Present”, Strings discusses her research with host Maddie Sofia. The conversation starts with Sofia’s voiceover, “But Sabrina started digging, looking at 19th-century magazines like Harper’s Bazaar, and what she found was troubling; articles warning American women—well, middle and upper-class white women—that they needed to watch what they eat.” A soundbite of Strings plays, saying, “And they were unapologetic in stating that this was the proper form for Anglo-Saxon Protestant women. And so it was important that women ate as little as was necessary in order to show their Christian nature and also their racial superiority.” Essentially, Strings is explaining that these magazines were linking skinniness to whiteness. This racist origin of diet culture further goes to show that valuing solely thin bodies makes no sense. Additionally, it makes it that much more terrible that the healthcare system still judges people’s health based on their weight. We must remember that diet culture was never a benevolent or innocent system. It was never about helping Americans be healthy, or about true beauty, and it still isn’t today.
In the end, I hope that learning about the history of diet culture and our society’s emphasis on weight loss helps those struggling with poor body image, no matter their race or gender. I know that when I have negative thoughts about how my body looks, it helps to remember that the reasons why our society praises being skinny are devoid of real credibility. In order to advocate for a more equitable and reliable healthcare system, including getting rid of the BMI, we must start by loving ourselves and our bodies.
