Everything you miss when you think weight loss is about willpower

In American culture, it's bad to be fat. Rarely is this more apparent than at the start of the new year, when diet culture, fat phobia and capitalism converge. Exploiting body shame and people's desire for renewal, weight loss companies ramp up ads, gyms reduce rates and diet companies promise to help people realize the elusive goal of weight loss that lasts. 

Sociologists and medical professionals who treat patients using a model of health at every size say this yearly cycle underscores society's obsession with thinness and fuels dangerous misperceptions about the relationship between weight and health.

January's anti-fatness may be cloaked in wellness and body positivity, but its core message to potential customers is the same it has always been: Their body is not good enough, and they have not been disciplined enough to lose weight. Sociologists say that message also suggests weight and health are solely the product of individual choices rather than the result of sexist, racist and classist systems. 

"People are doing this to avoid the social stigma, the economic stigma, the moral stigma of being fat or just not being as thin as they could be," said Natalie Boero, a sociology professor at San Jose State University and author of "Killer Fat: Media, Medicine and Morals in the American Obesity Epidemic." "If it were about health, we would be talking about access to health care. We would be talking about the toll of discrimination against fat people in medical settings, as well as in social settings. We would be talking about access to food and activity and education and economic security. We certainly wouldn't just be talking about people above or approaching a certain weight."

An anti-fat society

Implicit in the barrage of New Year's weight-loss ads is the belief that thinner is healthier. Fatness is threatening, and as some scholars such as Sabrina Strings have found, also linked to anti-Blackness.

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"By the early 20th century, slenderness was increasingly promoted in the popular media as the correct embodiment for white Anglo-Saxon Protestant women. Not until after these associations were already in place did the medical establishment begin its concerted effort to combat 'excess' fat tissue as a major public health initiative," Strings wrote in her book "Fearing the Black Body: The Racial Origins of Fat Phobia. "In this way, the phobia about fatness and the preferences for thinness have not, principally or historically, been about health. Instead, they have been one way the body has been used to craft and legitimate race, sex, and class hierarchies." 

The relationship between weight and health is complex. Natalie Ingraham, a sociology professor at California State University whose research focuses on the intersections of body size, gender, sexuality and health, said that when health is defined and measured by medical professionals who tend to be white and male, that can lead to discrimination against certain bodies. The same is true of wellness and nutrition spaces led by white women.

Dr. Gregory Dodell of Central Park Endocrinology in New York City said some medical professionals are questioning body mass index (BMI) as a marker of health. Rather than focusing on the scale, Dodell takes a holistic approach by assessing his patients' overall health and related behaviors, including exercise and nutrition. 

"We know that people can be healthy across the size spectrum," he said. "I have patients that are 'normal BMI' that have Type 2 diabetes. And I have patients that are well above 'normal BMI' that don't have any health problems. If you hide their weight, if you just compared their labs to each other, you'd think the person with the poorer labs was the heavier person. It's not always true."

Dodell is part of a growing community of medical professionals who say the risk of obesity, typically defined by BMI, has been overstated.

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"We don't expect you to be healthy because you weigh 300 pounds, and it seems that you're fighting a battle that you were never meant to be healthy, which is just not true," he said. "I have patients all the time who come in and say they avoid doctors because every time they go – for a sore throat, for irregular periods, diabetes – all they say is, 'Well, you really should lose some weight.' And they've made the assumption that that person is not exercising or not eating healthy when they're actually doing yoga four times a week, meditating and eating plenty of fruits and vegetables. There's so much stigma around weight in our culture."

95% of people who diet gain back their weight 

Goal-setting around health in the New Year isn't inherently problematic, Ingraham said, but goal-setting toward weight loss, in particular, is setting people up for failure. Ingraham said research shows 95% of people who diet will gain back their weight. 

"It's not that people should never watch what they're eating or never have to change what they're eating. But I think the change toward eating particularly focused on weight loss as the main outcome is just a boulder up the hill, and your body's going to fight you back on it. It wants to be at a certain weight, a certain size, and it's going to do what it can to stay there," she said.

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Dodell said people in larger bodies are the ones most likely to have dieted in their lives. 

"The most likely outcome of dieting is weight regain, which metabolically is shown to be worse for people because you go into this restrictive state, which gets you into this January – lose 30 pounds in 30 days. What happens in February?" he said. "This weight cycling increases inflammatory markers, it increases stress response. It actually may even reset our set point so people not only gain the weight back that they lost, but more. And what does that do to your body? Your body just throws up its hand and is like, 'What am I supposed to do now?'"

Ingraham said not every body can or should be thin, and people have less control over their weight than diet culture would have them believe. 

"The language is definitely about willpower, it's about overcoming mental blocks to these things," she said. "Much like a lot of public health messaging, it's very individual-focused. It's about how much individual willpower do you have to eat X amount of calories or X amount of points or whatever your system is. It ignores so many structural things." 

Individual choices not the sole driver of health

While everyone can strive to make healthy choices, sociologists say weight and health are not determined by individual choices alone. 

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"That message ignores food deserts and poverty, which is such a huge driver of health issues, because what choices do people really even have to make if they can't access good food and there aren't safe places for them to do outdoor physical activity, or if they will never have the money to join a gym, or they're working 60, 70 hours a week," Ingraham said. "The structural pieces make health really challenging because so much of health status is tied to this intersection of race and class."

Boero said the weight loss industry needs people to believe in the myth of self-discipline. Structural realities are not profitable.

"That doesn't sell anything. That doesn't give people a sense of control. That doesn't keep people anxious about where they fit in a social system," she said. "During this pandemic, many of us have felt so out of control, and I think there's a way in which diet companies or various 'wellness companies' or 'body positivity companies' will continue to capitalize on this idea that this is under our control."

The irony, Boero said, is that in the middle of the coronavirus pandemic, "we still haven't grasped that our health is about more than our individual behavior."

'Who benefits from us feeling terrible about ourselves?'

At the start of the New Year, experts say people who want to renew their focus on health should take time to examine what health means to them.

"Brace for what's coming, know that there's going to be this onslaught of messages in January that you need to reinvent yourself, that there is something wrong with you that needs fixing with a New Year's resolution," Ingraham said. "You can push back on that mentality to say, 'I'm doing OK actually.' Or maybe there is something you're wanting to change about your lifestyle that is in your control, and I think it's OK to set that goal. Just don't let a corporation set it for you."

You may not be able to control your weight, and some medical professionals would argue you may not need to, but you can control eating more vegetables, drinking more water, finding moments to breathe, and exercising in ways that don't feel punishing.  

"If we cared about fat people's health as a society, there are a million things that we would do before we shamed people, before we prescribed people diet after diet after diet that frankly ends up draining their systems, likely making people weigh more over time," Boero said. "It's worth asking, 'Who benefits from us feeling terrible about ourselves?'"