How the Deprivation Cycle Impacts Your Clients’ Mental Health (Diet Culture Series | Part 2)

In Part 1 I introduced the four Diet Culture Myths that shape our expectations and allow us to navigate our place of belonging in the world and avoid rejection. In other words, I laid out the rules of the game that promise us safety, belonging and a sense of worthiness if we have it in us to win.

In Part 2 here I explain how weight stigma raises the stakes by determining how society treats the game’s winners and losers.

Let’s jump in.

Remember from Part 1 that Diet Culture’s Myths make us believe that our health and body size are a matter of personal responsibility and completely within our control. So if somebody isn’t thin, it’s by choice. Or by weakness. Some innate characteristic of inferiority. 

Because after all, we all know that:

Good (healthy/thin) people will have good (healthy/thin) bodies because they make good (healthy) choices. 

That’s why you can tell how healthy somebody is just by looking at them. And by extension what kind of a person they are. That is key here.

This means that any casual observer has the permission to pass judgment on somebody else who clearly doesn’t care enough to, or isn’t able to, do what it takes to be healthy. 

The larger the body, the more stigmatization and discrimination the person faces. The greater the pressure to eat healthy and lose weight. Or at the very least to demonstrate that they are pursuing health (and trying to lose weight) and are therefore a good and worthy person. Or at least they are trying to be.

While these stigmatizing beliefs about weight, health and size are not true*, they are deeply embedded in our social structures and institutions.

These structures and institutions are broad reaching and cover a whole range of services and areas of life. Here are just a few areas where we can see the very real consequences for those who lose the Diet Culture game. 

In the area of Healthcare

Insurance Coverage: Certain body sizes or conditions that are thought to be “weight-related illnesses” could increase the premium that you pay for insurance coverage every month. They could also exclude you from getting certain procedures covered by insurance. 

Fertility Treatment and Maternity Care: Women in larger bodies are prescribed weight loss before getting pregnant. During pregnancy women are still pressured to maintain a low weight (arbitrarily designated by the faulty and problematic BMI). Even though a body in a state of energy deprivation prioritizes survival over reproduction which makes it harder to get pregnant and could even harm the growing fetus and expecting mother.

Weight Bias in Healthcare: Research shows that Doctors are more reluctant to perform pelvic and cervical exams on higher weight patients. As a result of these stigmatizing attitudes and weight based shaming from Doctors in general, higher weight patients are less likely to pursue these preventative care services. Anticipating, often correctly, that the Doctor will simply recommend weight loss instead. This stigmatizing environment that is an obstacle to preventative care contributes to the identifiably higher rates of cervical cancer in higher weight patients. 

Access to Evidence-Based Healthcare: Doctors often prescribe doomed-to-fail-weight loss for their patients in larger bodies rather than the evidence-based care that they provide for their thinner patients who have the exact same conditions. 

Denial of Body Autonomy: Higher weight patients are more likely to be denied their right to Body Autonomy. Instead, rather than being given the right to informed consent and empowered to make their own decisions, their Provider may only be willing to focus on their weight. Some Doctors treat higher weight patients with paternalism and condescension. Believing that losing weight is the only kind of treatment they need. 

In the area of Employment and Economic Capital

Wage Gap: On average, higher weight people earn 10-15% less than their lower weight counterparts.

Employment Opportunities: Higher weight people are more likely to be passed over for jobs and less likely to be promoted.      

Legally Approved Discrimination: Michigan is the only state to have explicit protections under anti-discrimination laws for weight and height. A handful of cities across the U.S. have laws protecting people from size discrimination. Otherwise, the only recourse a person has against weight-based discrimination is under the Americans With Disabilities Act (ADA).

In the area of Socio-Cultural Belonging

Cultural Representation: Stereotypical media portrayals of larger bodied characters are shown as side characters who are friendly but not taken seriously and serve the purpose of making the thinner main characters look more favorable in contrast. Thus reinforcing socially approved weight-bias.

Weight-Bias in Children: Studies show that kids begin associating “fat” with “bad” as early as three years old. 

Access to Physical Spaces: Many public and private spaces exclude higher weight people with very few voices advocating for the inclusion of people of all sizes. From having to purchase two tickets on a plane, to being turned away from amusement park rides, to not having the appropriate sized medical equipment. The message is clear. “If you don’t fit here, that’s your problem. If you want to belong here, you need to be smaller”. 

The constant pressure to eat healthier is clearly not just an individual preference that happens in an isolated bubble. The internalized cultural expectation to “eat healthier” is loaded with moral, social, economic and health implications. 

Let’s get back to your client.

Research shows that the rejection and discrimination that comes from being stigmatized has seriously negative effects on our physical, mental and emotional health. 

Internalized stigma in particular is associated with low self esteem, negative self-perception and increased anxiety and depression. Research also shows that even just the perception of being “overweight” or even just eating something “bad” increases anxiety and has noticeably negative physical effects on the body.

If appearing healthy (aka thin) is so important, then why are so many people (including your client) struggling with it? Why don’t they just do it?

Because it’s actually not that easy. We are actually physiologically wired to resist weight loss. Our body rebels against the deprivation that comes from trying to burn more calories than we eat. 

That’s what we explore in Part 3. One way that Diet Culture sets us up to fail over and over. Leaving us stressed out, undernourished and desperately trying to escape the shame that we believe that we deserve.

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Want to go deeper?

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