The Cost of Thin

A headline came across my news feed yesterday, about a prominent celebrity (lets call her "Kim") who had tweeted about how the flu was an amazing diet that had allowed her to lose weight right before her appearance at an event - what perfect timing! Normally I ignore or laugh at these types of stories, but this one has been bugging me for the last 24 hours. My first reaction was to roll my eyes and shake my head because, really, it is just so ridiculous. But I think it's stayed on my mind because as much as I like to think I am superior to this kind of stupidity,  I can clearly remember a time when I would have thought something similar.

I can remember being ill for a whole week in my early 20's - sick enough that I missed a week of school and could barely get out of bed. When I was finally strong enough to get up and get dressed, I remember feeling astonished that my jeans felt looser, and my stomach was noticeably flatter. As crappy as I was feeling still, this thrilled me, and I was determined this would be my new "normal" weight. Of course, my sheer determination was no match for biology, and once my illness passed, my appetite returned and I was adequately re-hydrated, my wise body swiftly returned me to my natural weight.

This is a picture of me with my parents and my hubby when I was about twelve weeks pregnant with my first son. The picture was taken at the restaurant where we were having dinner, moments after we'd announced that we were pregnant. Looking at this picture, I am always reminded of how often I was told that I looked great around that time. My skin and hair were glowing from hormones, my breasts had grown as well, but also, I was thinner. I'd lost about eight pounds in fact, largely due to throwing up daily for the six weeks prior. My doctor was getting concerned and I honestly had never felt worse in my life. I remember once, feeling so miserable and sorry for myself, I decided to treat myself to a pedicure, and was sitting in the auto-massage chair, only to have the vibrating chair trigger waves of nausea that had me dashing out early and barely making it to my car before throwing up in a plastic bag. I know that a lot of women have had morning sickness worse than I did, but I really did feel awful at the time, tired and nauseated and nibbling on almonds and soda crackers all day long. Even in this photo, I felt pretty terrible. Yet all I heard was people telling me how fantastic I looked, how I'd never looked better - without even knowing that I was pregnant. So maybe it was the pregnancy glow that was at play, but my guess is more than likely it was the weight loss that everyone was drawn to and compelled to comment on. 

I always think of this as an example of how we really have no idea, by looking at someone's exterior, what is going on with them on the inside. Appearances can be so deceiving, and we are often so quick to judge others based on appearance alone. A person in a larger body will be judged and labelled as lazy, undisciplined and lacking in self-esteem - yet they could be a picture of perfect health and be leading a full and meaningful life. On the other hand, someone who is in a thin body may be chain smoking, dieting, exercising two hours a day or self-inducing vomiting three times a day - yet they would still earn the admiration and approval of strangers based solely on their physique.

Yet what bothers me even more, going back to the "flu diet" headline, is the fact that young girls and women are taught over and over again, over the course of a lifetime, that thin is better, thin is healthier, thin is the only thing that matters. So much is riding on it that the act of violent vomiting due to illness is something to be celebrated, even if on the surface it seems in jest. In body physique competitions, the acts of starvation and dehydration are imposed to obtain a physique that is viewed as healthful. People use dangerous methods to obtain thinness, in the name of health - appetite suppressants, laxatives, self-induced vomiting and dehydrating, starvation - and are rewarded and praised for doing so. In my years working in critical care in hospitals, I can't count the number of times when an individual lost significant weight after a prolonged stay in ICU, putting them at a pretty high risk of malnourishment which delayed their recovery, only to be lavished with praise and admiration for their new and improved physique. They were bound and determined to keep their new weight, once again all in the name of health. 

Popular television culture reinforces this message as well. Weight loss shows continue to be popular, despite the fact that it's more apparent than even that the off-camera re-gain will be swift and unavoidable. Celebrities who are so clearly suffering from raging eating disorders (from my perspective as an eating disorder dietitian I can spot the signs immediately) are admired and given their own reality shows recruiting people for "revenge diets."  

It all seems like such madness.  And it would be one thing if the pursuit of thinness at all costs did actually result in improved health. But it doesn't, and in fact it almost always worsens health - an outcome that many are happily willing to accept as long as their bodies remain thin.

A culture that promotes thinness at all costs, that masks it as health, is a culture that is sick and harmful to everyone. It reinforces weight stigma which is not only hurtful to people in larger bodies, but to people in bodies of all shapes and sizes. If you're fat, it is pretty much the worst thing you can be, and you're guaranteed to be judged, ridiculed and discriminated against. If you're not fat, you live in terror of ever being fat - so much so that you'll engage in ANY behaviour to keep weight gain at bay - health consequences be damned.

I am patiently waiting - actually longing - for the day when this is no longer the norm, and we can start to accept and embrace a wide range of bodies as normal, healthy and attractive. When we can start to focus on behaviour changes and creating healthy habits that are entirely separate from weight. The irony is, changing habits can have such lasting profound effects on health, but out of all the behaviour changes out there, weight change is the one that we have the least control over (it's mostly dictated by genetics) yet the only thing that we obsess over in our society. Not only that, but it's the one that is associated with negative health consequences in the long run (long term dieting = weight cycling = weight gain and/or development of disordered eating).

I feel like the shift will happen slowly, and is already happening, yet it's hard not to feel like I'm struggling against the tide, fighting an uphill battle. I believe in this cause wholeheartedly though. I draw inspiration from the courageous people around me and that I work with who are brave enough to fight the status quo, and are filled with wonder, empowerment and freedom when they discover how their lives and health (physical and mental) change for the better once they finally drop the diet culture tug-of-war rope.