My Biggest Professional Regret
If there is one day I wish I could erase from my professional life, it was the day back in the late 2010s when I held a class on using Cognitive Behavioral Therapy skills for weight management. This was long before I became an anti-diet therapist. I was working at a medical clinic focused on treating spine issues.
My role as a psychotherapist in this clinic was to help the people who were having mental health issues related to their pain. I quickly realized that there was a lot more that could be done to help our patients besides treating their mental health symptoms that resulted from pain — I could actually help them address the pain itself.
Most people that I saw in my therapy office were missing basic pain management strategies like activity pacing, relaxation skills, and knowledge about what pain means and how it works. The medical system in the United States does not support in-depth patient education, so I wrote a grant for our clinic to hold classes to teach patients these things.
I decided that one of the things people needed to know was how to stick to diets so they wouldn’t be so fat and their backs wouldn’t hurt (I am using the word “fat” as a neutral descriptor in the tradition of fat activists as the words obese, overweight, and obesity depend on the harmful and outdated concept of an “ideal weight” and BMI). Knowing what I know now, it hurts me to write these words.
While the pain management strategies in these classes were generally not problematic (though these days I would probably add in some classes on self-advocacy and fighting internalized ableism) the idea that if I could help our patients lose weight their pain would improve was firmly rooted in diet culture, and very very wrong. There is a lot of evidence showing that people of all sizes get pain and weight loss does not typically result in less pain.
What is Diet Culture?
Diet culture is based on the idea that the size of one’s body equals one’s health, and by association, one’s worthiness. In diet culture, thinner is better. In diet culture, if you are not at your “ideal weight” (which is based on the outdated, racist, and unscientific measurement, the BMI), you should be on a diet. Body size is linked to morality in diet culture — if you are fat, it’s because you are lazy (don’t exercise), stupid (don’t know what to eat), or lack willpower. All of this is wrong and not based in the science.
These days diet culture often masquerades as wellness culture or “clean eating.” I get it — for many years I told myself that I was following a specific eating and exercise plan (i.e. diet) in order to “get healthier.” Unfortunately, diet culture told me that skinnier = healthier, and that is what I was really going for.
If you question whether you have been sucked into diet culture that is masquerading as wellness, ask yourself how you know you will be healthier when you have achieved your goals for your eating plan — is it a particular lab level you want to improve or a number on the scale? If it’s a number on the scale, I’m sorry to say that it’s a diet.
My History with Diet Culture
Before I was an anti-diet therapist, I was a teenager in the 1990’s. Maybe I could end this section here, but for those of you who blessedly don’t know what that means, it was the era of Snackwells diet cookies (they were disgusting), low fat everything, and heroin chic. Oprah’s wagon of fat had been wheeled out on stage in 1988, and everyone and their mother was on a diet.
My body comparison started young — I have a vivid memory of sitting in a row of girls as a grade schooler and checking to see if my thighs were as big as the girl next to me, hoping to be assured that I was not the biggest girl in the room. In my family, I was praised for being a “good eater” as a kid (this is what comes from being the descendant of German-Bohemian Wisconsinites), but also cautioned against eating too much lest I not fit through the bathroom door.
I don’t remember a time that I didn’t believe that my body was too big, but it wasn’t until after college that my eating got a bit weird. I had periods of following a low fat diet, but then binged because I was not eating enough (as one does). I went vegetarian for ethical reasons (but also to lose weight). I went on phentermine twice (it’s the phen in fen-phen), and I did Weight Watchers.
I have downloaded and deleted calorie counting weight loss apps many times. I religiously ate Daily Harvest meals for months, including trying to substitute some kind of frozen mushroom thing for ice cream (it’s not the same). I had forays into keto and paleo. The fanciest diet I ever did was Zoe, which promised to reveal the ideal foods for me if I sent in blood and poop samples (I learned that my microbiome is wrecked — this is not actually a thing — and I should eat more vegetables — not a surprise). I flirted with Noom until I realized it was another diet, approximately 2 hours after signing up.
Why I Decided to Break Up with Diet Culture and Become an Anti-Diet Therapist
None of these diets worked in the long term. Sure, they would work for a few months, maybe even a year or two, but they all, without exception, ended with me gaining the weight back, and then some. That is, they supported what we see in the data. We have over 100 years of science supporting the fact that intentional weight loss typically works in the short term, but people gain the weight back and more. We also know that health outcomes are worse for people who yo-yo diet, which is what I was doing, and which is what any chronic dieter does.
Because I care about my health and wellbeing, I have decided to stop dieting or making “lifestyle changes” that are diets in disguise. I have finally dropped the rope in my struggle with weight, and I feel better, stronger, and healthier than I have in a long time.
In doing this, however, I have to acknowledge my “small fat” white cis woman privilege. As a “small fat” (someone who is between straight sizes and plus sizes) woman, I can go into many stores and find some clothes that fit, I can definitely find clothes online that fit, and medical care is not inaccessible to me due my size.
This is not true of people in larger bodies than myself, and we have a lot of work to do to make our society more equitable for people of all sizes. Also, as a white cis woman I have considerable privilege, and thin privilege is something I can afford to stop striving for with fewer consequences for my credibility, social standing, and career than others might be able to. This is also unfair.
There were a number of books and media that helped me get to this place of being able to ditch diet culture and become an anti-diet therapist. I strongly recommend the following: the podcast Maintenance Phase, newsletters by Virginia Sole-Smith and Ragen Chastain, the books Anti-Diet by Christy Harrison, The F*ck It Diet by Caroline Dooner, Fearing the Black Body by Sabrina Strings, Body Respect by Lindo Bacon and Lucy Aphramor, and Intuitive Eating by Evelyn Tribole and Elyse Resch.
What Does it Mean to be an Anti-Diet Therapist?
Now I can state proudly that I am an anti-diet therapist. What does this mean? It means that there are things that I will not do any more:
- I will not endorse weight loss as the solution to any problem.
- I will not help you “develop the willpower” to stick to your diet or exercise routine.
- I will not participate in the mythology of diet culture that says that if you just tried harder you could change your body.
- I will not make assumptions about your health or habits based on your body size.
- I will not treat a “food addiction” (because that’s not a thing).
Things I Will Do as an Anti-diet Therapist:
- Support your efforts to eat food that nourishes you physically and emotionally.
- Support your efforts to move your body in ways that feel good to you.
- Help you reduce shame about nourishing yourself.
- Help you feel better about your body as it is.
- Bust myths about diet culture with you.
- Help you identify the origins of the stories you tell yourself about your body so that you can change those stories to be more helpful to you.
- Help you identify when diet culture is part of your negative self talk or self-harming behaviors so you can boot it out of your brain and feel better about yourself right now.
- Help you stop putting off doing things that are fun/rewarding/meaningful until “after you lose weight” and start living your best life now.
If this sounds good to you, give me a call at 651-998-8991 or fill out the “contact me” form below to learn how we can start working together to help you break up with diet culture for good.
ABOUT THE AUTHOR
Erin Brandel Dykhuizen, MA, MSW, LICSW is an anti-diet therapist who offers counseling for adults with PTSD, trauma symptoms, and chronic pain in St. Paul, Minnesota. She also works with individuals via remote, online counseling throughout the states of Minnesota and North Dakota. You can learn more about Erin’s Twin Cities therapy practice at erinbdlicsw.com, or reach Erin by phone at (651) 998-8991.
