Diet culture and harm reduction
By 
Jennifer Weiner has an essay on how Oprah Winfrey’s 40-year history of constant weight cycling epitomizes the destructive absurdity of diet culture:
I also believe that Ms. Winfrey was part of the problem, even as she sought to find a solution for herself — that she both suffered under diet culture and paid her suffering forward, profiting from the idea that all of us had to be thin and that all of us could be, if we just tried hard enough.
She pushed diet after diet in her magazine. “Weight! Take It Off, Keep It Off. Do It Right This Time,” read a typical cover. “3 Crash Diets Doctor Approved!”
She put before-and-after pictures of herself on the cover, setting a photograph of her skinny circa 2005 self, in a midriff-baring top, beside a shot of a heavier 2009 version, with a line lamenting, “How did I let this happen again?”
It went beyond using her platform to elevate Dr. Oz and Dr. Phil, this celebrity trainer, that celebrity chef. In 2015, Ms. Winfrey bought 6.4 million shares of Weight Watchers, worth $43.2 million, giving her a 10 percent stake in the company.
Ms. Winfrey made money when Weight Watchers preached the gospel of points and self-control. She will likely make money now that Weight Watchers has added medications to its arsenal, especially because her new-body reveal comes on the cusp of New Year’s resolution season.
I wonder if, someday, we will look back at this moment when, for a blink, people tried to push back against diet culture. When there was slightly better representation. A smidge more inclusion. When there were larger women, with bellies and stretch marks, in the Sports Illustrated swimsuit edition and Victoria’s Secret ads. When some of us tried to tell our daughters — because it’s women who still bear the overwhelming brunt of weight stigma — that our bodies are not a problem to be solved, that health and happiness, beauty and strength are not tied to a number on the scale.
When, instead of trying to change ourselves, we had a chance to change the world but then fell prey to a familiar siren song: here, at last, a solution that works (as long as you can find the medications and afford them and tolerate them and are prepared to keep taking them) and Ms. Winfrey, the world’s most famous dieter, thin at last, thanks in part to the magic of medication, just before her 70th birthday. Never mind that Virginia Sole-Smith, the author of “Fat Talk: Parenting in the Age of Diet Culture,” told me that what Ms. Winfrey describes as a “healthy lifestyle,” including eating the last meal of the day at 4pm, isn’t one Ms. Sole-Smith would want a young person to emulate. “If you’re a kid with soccer til 5pm, this is very dangerous. You need to go home and eat dinner,” Ms. Sole-Smith pointed out.
20 years ago, I wrote a book pointing out that the American public health establishment’s definition of “healthy weight” as consisting of a BMI of between 18.5 and 24.9 is both profoundly unscientific and culturally pernicious. For one thing, people in this weight range do not, on average, have better health or life expectancy than people in the so-called “overweight range” of BMI 25 to 29.9. Nearly one third of American adults are currently in the “overweight” [sic] range.
But even if we ignore this remarkable fact, there’s a deeper absurdity at the core of the diet culture, which is this. Assume for the purposes of argument that people in the so-called healthy weight range really did have, as a matter of statistical correlation, better health on average than people had on average outside that range. What would have to be true to make it reasonable for the public health establishment to advise people outside the “healthy weight” range to try to put themselves in it?
(1) That it was possible for a reasonably high percentage of people to do this in the first place, and remain in that range.
(2) That on net, attempts to do this, both successful and unsuccessful, produced more benefits to health than damage to health.
(3) That it had been demonstrated that people who were outside the “healthy” weight range, absent successfully maintained weight loss, would then have the same health on average as people inside that range, once they had engaged in whatever behavior produced the successfully maintained weight loss.
It would be an understatement to point out that none of these things are or have ever been the case. Making weight loss a target of public health intermediation is a nonsensical goal, that does vastly more harm than good. The diet culture is merely the most obvious (and profitable) manifestation of this destructive nonsense.
Encouraging people to engage in healthy behaviors — which very clearly does not include focusing on permanent long term weight loss as a goal — is a far better harm reduction strategy that telling everyone that they should try to have a BMI of between 18.9 and 24.9 for the sake of their health. This makes about as much sense as telling everyone they should try to be a woman rather than a man, or to be younger rather than older, for the “sake of their health,” and for much the same reason.