Rethinking Food: Does the health sector need a paradigm shift?

Illustrated by: Zoe Dolinsky

Food is an integral part of our lives. Beyond our internal health, the foods we eat are crucial components of our social and emotional well-being. However, some argue that Western cultures need to rethink how we think and talk about food. Dietician and UCLA health educator Eve Lahijani claims that common misconceptions that “food is fuel” may be oversimplifying the complex role of food in our lives [3]. The human body is much more than a simple machine running on fuel. While food is an important source of energy, such oversimplifications ignore the emotional and social role food plays in our lives. As Lahijani explains, our experiences with food surpass a biological necessity for nutrients and are “entangled with different emotions, ideas, memories and rituals” [3]. Despite this, health professionals have stuck to a paradigm that largely oversimplifies how we should think about food.

In the United States, concern about the national obesity epidemic has led public health policy and private industries to fixate on weight loss promotion [2]. A person’s weight is used as a direct measure of their health. Every time you go to your annual checkup at the doctor’s office, a nurse is likely to take your height and weight in order to measure your Body Mass Index (BMI). BMI is a heavily relied upon primary health measure in which the only factors considered are height and weight. Based on BMI, an athlete could be considered overweight and a bodybuilder obese. Partly because the data is easy to collect, BMI has long been a standard measure of health [15]. Yet BMI fails to consider both the internal complexity of the human body and the cultural stigmas that come along with labels like “overweight” and “obese.”

This begs the question: is a weight-centric paradigm really promoting health? Many activists and health professionals including therapists, psychiatrists and nutritionists like Lahijani are calling for a paradigm shift in the way we think about nutrition and health. There is a call to move away from a focus on weight loss and instead adopt a mentality of health at every size (HAES) [2]. Developed by nutritionists Lindo Bacon and Lucy Aphramor, HAES shifts emphasis away from weight control and prioritizes holistic health promotion [2]. HAES has been supported by eating disorder organizations such as the National Eating Disorder Association, civil rights groups such as the Council on Size and Weight Discrimination and professional organizations such as the Association for Size Diversity and Health [2].

This holistic health paradigm considers our physiological, psychological and social relationships with food. Contrary to traditional beliefs, extreme weight gain does not result from a lack of will [11]. For many, it is not a result of a lack of health knowledge or education [17].The reality is that even for people who know which foods they “should” and “shouldn’t” eat, changing eating habits is incredibly difficult. The new paradigm recognizes that there is not a simple solution in facing the obesity epidemic, rather we need to consider the reasons why poor eating habits occur and how to effectively change the habits long-term.

A major reason why nutritionists and other health professionals are considering a new paradigm is because the traditional paradigm has been unsuccessful. Despite overwhelming weight loss promotion, obesity rates have continued to climb [12]. Weight loss attempts often result in short-term weight loss without long-term health benefits [9]. Diets tend to cause weight cycling or “yo-yo dieting” in which one repeatedly cycles between weight loss and weight gain [16]. This happens because when a person restricts their food intake, they are physically and psychologically depriving themselves. Dieting often causes a person’s metabolism to slow in order to conserve energy. At the same time, restriction causes a person’s appetite and cravings for restricted foods to increase [6]. Thus, when a person breaks their diet, they are very likely to overeat. This is worsened by feelings of failure and beliefs that they have no self-control [6]. A person’s self-esteem and body image are likely damaged, leading them to be unhappy with their appearance or weight and go on another diet. Thus, this cycle continues.

Weight loss promotion has also had devastating consequences for national health. As Bacon and Aphramor explain, a cultural fixation on weight has contributed to increased eating disorder concerns. Focusing on weight control and physical appearance can encourage disordered eating [5]. This includes skipping meals, rigid food routines, chronic weight fluctuations, feelings of shame, using exercise or food restriction to compensate for food consumed, etc. [1]. Despite the fact that eating disorders are traditionally associated with lower-weight individuals, several studies have found that the prevalence of eating disorders are in fact higher among obese individuals [8]. What is especially concerning is that eating disorders are often underdiagnosed among higher-weight individuals [18]. This happens because physicians tend to praise overweight or obese people for habits like calorie counting, which would be considered signs of eating disorders for lower-weight individuals [18].

Unhealthy eating habits such as binge eating, overeating and emotional eating result from various compounding psychological phenomena including a range of emotional states. This includes stress, depression and other negative emotions [7]. A person does not develop binge eating disorder just because they lack self-control [13]. Eating disorders, including binge eating, are exacerbated by restrictive eating habits [6]. Previous weight loss attempts are also a primary predictor for the development of an eating disorder [18]. Despite the fact that eating disorders are considered mental illnesses, they can detrimentally affect a person’s physical health and life expectancy [4]. Thus, supporters of a paradigm shift argue that when promoting physical health, physicians and public health professionals need to carefully consider the consequences of weight stigma.

Despite the failures of the weight-focused paradigm, would a weight-neutral paradigm be successful? Health promotion programs that de-emphasize weight and consider holistic well-being have been found to be more successful for long-term health benefits [2].  Research participants experienced superior physiological measures, better eating habits and improved mental health whereas weight-centric approaches lead to lower self-esteem and poorer body image, further exacerbating unhealthy eating habits [2] . The important thing to keep in mind is that while the new paradigm encourages individuals to focus less on their physical appearance and weight; it is not encouraging people to ignore nutrition. It considers nutrition in the ways it affects one’s mood, energy and life expectancy.

Many nutritionists including Lahijani and the creators of HAES support a modern food movement known as intuitive eating, in which people are encouraged to become attuned to their body’s hunger and fullness, ignore traditional food rules and shift away from views of food as reward or punishment [3]. This approach has been found to improve people’s nutrition, reduce disordered eating and help people lower their BMI [2,10]. Intuitive eating also encourages people to attune to their body’s response to food. Intuitive eating emphasizes attentiveness towards both immediate sensory experiences while eating as well as subsequent effects on mood, energy, concentration, bowel movements, satiety, hunger and pleasure [2]. Intuitive eating is associated with greater interoceptive awareness, or the ability to recognize and respond to your internal sensations and cues [14]. Improving your interoceptive awareness allows you to better regulate your emotions and prevent emotional eating and overeating. Thus, increasing people’s interoceptive sensitivity is crucial in facing the obesity epidemic as it helps people change their habits by attuning to their bodies.

While disordered eating habits are exacerbated by the ways we culturally think and talk about food, it is up to health professionals to seriously consider what really is the best way to promote nutrition. Following in the footsteps of nutritionists like Lahijani, Bacon and others, we should adopt a paradigm that encourages people to eat in a balanced way, including foods that make them feel energized and satisfied. Health professionals should also be careful to consider how to promote nutrition without unintentionally perpetuating disordered eating habits.

If you or a loved one is struggling with an eating disorder, please seek professional help or call/text (800)-931-2237.

Edited by: Rehan Mehta
Illustrated by: Zoe Dolinsky

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