In part 2 of What’s Eating You, I introduced how the stress of being inundated with messages about how we must diet and lose weight to be healthy can itself directly lead to poor health outcomes. In this blog post, you will learn about some major ways that stress in the form of weight stigma, dieting, and medical mistreatment can lead to devastating consequences on our overall well-being.
Allostatic Load and Weight Stigma:
Allostatic load is a term referring to the progressive physiological wear and tear on the body due to chronic stress. Weight stigma, a type of discrimination against individuals based on their body weight, is a stressor that contributes significantly to allostatic load. Weight stigma operates on many levels, including from one person to another, in institutional or work settings, in society at large, and it can show up in various forms such as bullying, discrimination in healthcare settings, and negative portrayals in media. Experiencing weight stigma triggers stress responses in the body, including alterations in hormone levels, immune function, cardiovascular activity, and metabolic processes. While the stress response is a natural and adaptive mechanism that helps us cope with serious challenges, activating these systems on a consistent basis can lead to detrimental effects on health. Family members pinching our love handles, unrealistic social media images, negative self-talk, Slim Fast commercials, doctor’s telling us to “just lose weight” when we visit them for heart palpitations, leg pain, or a multitude of other reasons (a form of medical neglect), can all contribute to elevated levels of stress hormones like cortisol and inflammatory markers, ultimately increasing allostatic load.
Allostatic load can have profound effects on mental health and well-being. Chronic stress has been implicated in the development of mood disorders such as depression and anxiety, as well as cognitive impairment and neurodegenerative diseases. Consistently triggering this level of stress response can disrupt neurotransmitter balance, impair neural plasticity (our brain’s ability to adapt and learn), and contribute to structural changes in the brain, particularly in regions associated with emotion regulation, memory, and executive function. Ever notice that, despite (or because of) being on multiple diets, your levels of happiness, peace, patience with others, and balance hasn’t improved much? Or perhaps your anxiety, depression, short temperedness, or stress has gotten worse? If so, pause for a moment and reread this paragraph, considering the implications. Perhaps you’re not feeling better due to the physiological and psychological changes occurring on a biological level as a result of dieting and stress, not due to a lack of will power on your part or not having tried the “right” diet. Individuals experiencing high levels of allostatic load may be more vulnerable to psychiatric symptoms and less responsive to conventional treatments, further highlighting the importance of addressing underlying stressors in mental health care.
Weight stigma often leads to unhealthy coping mechanisms such as disregarding our body’s natural hunger and satiety cues, avoidance of healthcare, and decreased physical activity, further exacerbating physiological stress and contributing to poor health outcomes such as cardiovascular disease, diabetes, mental health disorders, and overall mortality. Addressing weight stigma is essential for promoting health equity and reducing the burden of chronic disease on individuals affected by weight-related discrimination.
The Over/Under Weight Dilemma:
By this point in the 4 part blog series, you have gotten a good baseline of the problematic nature of focusing on weight as being synonymous with health, and the disproportionate emphasis our society places on the need to lose weight. An additional significant factor that is missed in the diet culture narrative is the serious health risks associated with being underweight. When individuals are underweight, they may not have enough body fat to support essential bodily functions, such as hormone regulation, immune system function, and organ protection. Chronic underweight status can lead to weakened bones, increased susceptibility to infections, impaired wound healing, and reproductive issues. Additionally, being underweight is associated with a higher risk of developing eating disorders, depression, and anxiety. Several studies have shown that being underweight puts one at significantly higher risk of mortality than being so called “overweight’ or “obese.” (In a later blog post, I will explain why I put those two terms in quotation marks, but for now, just know that the way we categorize people’s weights utilizing the BMI has been proven to be deeply flawed). The immediate dangers associated with being underweight are more severe and can have serious long-term consequences on overall health and wellbeing. With this in mind, it makes you wonder—if promoting positive health is really what we are aiming for (like wellness or diet culture claims is the goal) why is there such an emphasis on the need to lose weight, and little to no conversations about the dangers of being underweight? Hmmmm.
Disordered Eating:
Speaking of underweight, there's a pervasive misconception surrounding eating disorders that equates them solely with being underweight, leading to a troubling phenomenon where individuals in larger bodies are often overlooked or dismissed when struggling with disordered eating. This misconception can result in delayed diagnosis, inadequate support, and perpetuation of harmful stereotypes. Eating disorders encompass a spectrum of behaviors and psychological distress related to food, body image, and weight control, affecting individuals of all shapes and sizes.
Disordered eating patterns such as binge eating, purging, and obsessive food restriction can occur at any weight. However, due to societal bias and medical stereotypes, people in larger bodies are frequently stigmatized and face barriers to accessing appropriate care for their disordered eating behaviors. In my own practice, several of my clients have come to me wanting help to “stop overeating” or “binging” when the reality is the most medically dangerous behavior they are doing, restriction, has been going on for years and no medical professional has assisted then with this. Most of these clients had regular doctor’s visits with blood work taken that showed evidence of potential malnutrition, but because these individuals did not “appear” underweight, they were either not given any referrals for disordered eating support, or worse, they were told they “just need to lose weight.” Talk about adding insult to injury! It’s essential to recognize that eating disorders do not discriminate based on body size and to promote inclusive and compassionate approaches to support individuals struggling with these complex illnesses, regardless of their weight.
Diets Don’t Work:
You may not need one more reason why promoting weight loss as the solution to health problems is problematic, but here’s another significant one: there is overwhelming evidence demonstrating that diets don't work in the long term and often lead to weight gain and weight cycling over time. I want to make it clear, if I have not already, that I do not believe weight gain is a “bad” thing (in fact I attach no moral associations to it), nor am I advocating against it. But if the whole goal in the wellness and medical industry is to “get people healthier by losing weight,” how is it that very action they are recommending leads to the opposite effect? Numerous studies, including the landmark "Minnesota Starvation Experiment" conducted by Ancel Keys and more recent meta-analyses, have shown that restrictive diets fail to produce sustained weight loss and can even result in greater weight regain once the diet ends, not to mention a slew of psychological and physical problems. The Renfrew Center has a great article on the Minnesota Starvation Experiment and its implications here: https://renfrewcenter.com/the-minnesota-semi-starvation-experiment-what-it-teaches-us-about-eating-disorders/
The "National Weight Control Registry," which tracks weight loss maintainers, found that the majority of individuals who are able to avoid weight cycling and stabilize their weight do so through lifestyle changes such as adopting a balanced diet and engaging in regular physical activity, rather than through restrictive dieting. And in case you’re wondering just how many people are able to lose weight and keep it off for longer than 5 years, that number on average is less than 3% to 5%. Most weight loss products or intensive work out programs will not include longevity statistics as doing so would clearly negatively impact their sales. They thrive off of keeping people hooked on their products by highlighting short term results and leading you to believe if you didn’t maintain those results, you are the problem, not their flawed system. Sadly, many of those 3% to 5% of people who are able to keep it off longer than 5 years do so by revolving their life around dieting and food in the form of disordered eating. I will discuss in a future post the “cost” of fighting against the body’s natural weight set point in the form of extreme weight loss and maintenance efforts, but know that any obsession and resulting behaviors related to weight loss is very much a monkey’s paw: it takes so much more than it gives.
Dieting disrupts metabolic processes, leading to physiological adaptations that make it harder to lose weight and easier to regain it, a phenomenon known as "diet-induced weight cycling" or "yo-yo dieting." Our bodies are adapted to ensure our survival, and cannot distinguish between voluntarily being on the latest diet trend vs being in a famine or otherwise emergency state. Therefore, recommending dieting as a solution for health improvement is problematic as it often produces the opposite effect, contributing to weight cycling (which as you learned is incredibly dangerous on the body and organ systems) and potentially exacerbating health issues in the long run. Instead, promoting sustainable lifestyle changes that prioritize balanced nutrition, intuitive eating, and enjoyable physical activity is crucial for supporting long-term health and well-being. As mentioned in each post of this blog series, Health at Every Size®️ and Intuitive Eating, used here at Nourished Minds Therapy, contain wonderful guidelines for sustainable holistic health.
Conclusion:
You can see how the stress of weight stigma, weight cycling, and dieting has far-reaching implications for physical and mental health outcomes. By understanding the mechanisms underlying these factors and their impact on disease risk and progression, healthcare providers can develop targeted interventions to mitigate stress, promote resilience, and improve overall well-being. This may include strategies such as stress management techniques, lifestyle modifications, social support, and pharmacological interventions aimed at restoring physiological balance and reducing the burden of chronic disease.
If you’ve stayed with me thus far in this blog series, truly, take a moment to give yourself appreciation; it can be incredibly difficult to be faced with a topic that goes against what most of us have been taught all our lives and have accepted as immutable truth. Cognitive dissonance abounds. I challenge you to lean into that cognitive dissonance a little longer, continue to challenge your own internal weight biases, and stay with me for part 4, the final blog in this series, where I discuss specific strategies to reclaim your physical and mental wellness from the grips of diet culture.
