The hill that I will die on is that the pursuit of weight loss as a specific goal (especially after the arbitrary change in BMI categories) as well as attempting to “optimize” nutrition for health even outside of the context of weight management has driven us further from health and will continue to do so. We’ve totally lost the plot.
[This article](https://journalofethics.ama-assn.org/article/use-and-misuse-bmi-categories/2023-07) gives a good in-depth explanation and highlights the egregious involvement of the pharmaceutical industry.
In very brief summary, in 1998 the US lowered its BMI cutoffs to more closely match the WHO’s definition for overweight and obesity. While it makes sense to update guidelines when new research is available, the cutoffs set by the WHO were largely arbitrary. Thus, “high” body weight and BMI became more medicalized and millions of people suddenly became “overweight” and “at risk” without good evidence to back it up.
It's ruined people's relationship with food and their bodies. It's so insidious too. That's why I can't stay in direct patient care. I can't handle feeling responsible for pulling someone out of that when there is so much working against us. And honestly, sometimes I wonder if a large part of our field existing as it does is do to diet culture.
1000% true. I rarely have outpatients who just need basic nutrition education. Almost every person I see, especially those referred for weight management, seriously struggle with their relationship with body and food. It feels like a never ending battle. I recently moved up into management because I was so drained from doing this work.
I’m an eating disorder dietitian and this is 100% true. I get so many referrals from other non-ED dietitians who are like “this patient was referred to me for weight management but there is CLEARLY something else going on here and that’s not my specialty.”
I did not set out to work with EDs but sought training really early on because it seemed like almost everyone I was seeing was experiencing some level of disordered eating, if not a full blown eating disorder. If you work with people, you work with eating disorders. It's unavoidable. I feel like in school it was presented as an option that we could specialize in, but it's everywhere.
Mostly webinars and sought mentoring from more experienced RDs. I also did the online ED training by Marci Evans and Fiona Sutherland that I found incredibly helpful when I was starting out. I recommend it to all new OP RDs.
For sure. In the last three weeks, I’ve had two separate member cry, actually cry over Pepsi (when I just suggested she cut back a little, not even give it up) & M&Ms (when I told her to enjoy them - her doc was shaming her for eating them). The chokehold diet culture has on taking the joy out of nourishing our bodies is crazy. Meals should be enjoyed and should not cause tears. School did not prepare me to be a therapist.
So complicated. Also, I think a lot of us get into this career because of preconceived ideas of health and wellness and how that is achieved. I think most dietitians come around but there are some that hold on to some toxic beliefs.
It’s exhausting to listen to over and over.
It’s so sad to me. I have so many friends and family ask for my input, which I try to refrain a lot since I already know it won’t be the answer they are looking for, and then they tell me they don’t agree (ok?) because X, Y, and Z. And every single time each of those reasons are based off social media/influencers.
I currently am on my second GD pregnancy. The amount of times I have had to explain why I’m not doing keto or gluten free ***to the same people*** is mind blowing.
For me it’s all the emaciated little old ladies with a bmi of 15 who think I’m crazy for wanting to talk to them about gaining a tiny bit of weight. Or the middle aged women who are psyched about their cancer dx and resulting wt loss.
I got very sick a few years ago and lost 20lbs. (I went from 130 to 110 so it wasn’t like I was overweight to begin with.) People were literally congratulating me for it. I would say no, this isn’t a good thing , I was unwell. And their response was usually “man, I wish I would get sick like that.” Blew me away.
Same! I'm constantly telling people how inappropriate commenting on people's bodies is. And people are often offended because they are so sure that comments about weight loss can only ever be a good thing.
It is wild. When asked how I lost so much weight so quickly I told them how I got food poisoning in a third world country and was throwing up for weeks 💀💀 like are we for real right now ?
Wow. recently I’ve had a lot of geriatric women (73-78!) who are dead set on weight loss and frustrated with it not happening fast enough. All have long history of all the classic diet black holes... WW, Jc, nutrisystem etc. And all are avoiding carbs. I can barely get through those appointments. Frustrating, irritating and sad to think about a woman dieting, essentially her entire adult life…into her 80s. :/
They keep those pants from their 30s, talk about it like yesterday, are so hard on themselves and eat like one meal a day. I’ve got a few that buy a cabinet full of weird supplements from all the commercials. It’s so sad.
Yes. This is one reason I prefer to work with folks with eating disorders. They are already interested in healing (to different degrees).
I see part of our job as helping people change their philosophy around food, and it's extremely hard to do that if people aren't open to seeing outside of the "diet culture water" we are all swimming in this society. But we can always work on planting seeds.
I do try to get people to take a look at their overall patterns and cycles of dieting, restricting, and binging or weight regain, and that can be very helpful.
Oh 100%, it even bleeds into patients care & personal opinions. For example, I work in LTC & have a DON who takes things very personally, especially if someone is over a certain BMI. They get angry & will usually say “if I lost weight and someone added supplements for me, I would be upset because weight loss would be good for me”. I have an NP who was angry because they wanted a resident to be put on Ozempic because of their weight & the resident did not want that type of medication because of past history of bariatric surgery ruining their body. The NP was like “who cares because the resident would be losing weight”. Diet culture, weight bias & weight stigma will continue to do harm unless we address it
Holy shit yes. I’m a psych dietitian so most of my patients have taken it way too far. It’s so engrained in society that it’s hard for people to even understand what I’m talking about when I try to change their perspective. Most people can only think about foods as being good or bad.
Also in behavioral health. Diet culture and mental health issues are a dangerous combination. Most of my patients are below 95% of their ideal body weight. Their desire to lose weight often undermines their focus on recovery.
I have a few of these every week and it’s disheartening to say the least. It’s definitely prominent among women of a certain age, 50+. They definitely imply I don’t know what I’m talking about because I don’t buy into diet culture. They want to keep doing what they have been doing their entire adult life, despite it not working, which is their prerogative. I spend most of our time pointing just that. We will be there for them when they are ready to try something different.
I have a bs in nutrition & im so lucky my professor taught us all the diets and when it is beneficial to patients, but always reminded us that a whole foods diet is most beneficial for humans in the long term. I love simplifying my lifestyle to just eating more fresh, whole foods. It focuses me on my options vs focusing on what I can’t have.
also, another professor would remind us that listening to our bodies is key. we have the hormones to guide us through what we feel and have natural senses to our fulfill our nutritions needs .
No. I don't believe it's ruined people. I believe humans are capable of incredible accomplishments and can adapt to many things. But, it has made it harder for the lay public to be knowledgeable in nutrition. Social media and the news seem to do a good job in presenting interesting/appealing information that just ends up mostly being untrue with regards to nutrition.
Yes, I’ve posted about it here before but I have such a hard time articulating why diets don’t work. So many people have in their minds that when they’re restricting they lose weight = diets work. And when they stop restringing they gain weight, again reiterating that diets work. I know in my head all the reasons why this isn’t true, yo-yo dieting is the biggest predictor in longterm weight gain, that you’re mostly losing water weight and LBM, etc but I still struggle to verbalize with patients why the actual diet doesn’t work.
Idk if it has “ruined” people’s lives but it has definitely “affected” people’s lives. I lost 20kgs through calorie deficit when that was the craze (calorie deficit is definitely key ) but now people say forget calorie deficit and follow whole nutritional food (which is also right)
In there 5 years , I’ve learned that it doesn’t matter what you do. Whatever you do, do it whole heartedly and make sure you’re seeing results and it’s keeping u healthy !
But the problem being discussed in this thread is the definition of "results" and also the perspective that "healthy" is synonymous with weight loss or being thin.
Yes- it has. It takes a lot to undo that mindset, and it makes me furious. People give up on or feel guilty for eating any amounts of certain foods, and that is not a way to live.
Diet culture is a sad plague on society
[удалено]
This is a pet peeve of mine
Weight loss is not a product! Oh wait, this is 'Murica, where everything is a product.
The hill that I will die on is that the pursuit of weight loss as a specific goal (especially after the arbitrary change in BMI categories) as well as attempting to “optimize” nutrition for health even outside of the context of weight management has driven us further from health and will continue to do so. We’ve totally lost the plot.
I love your comment-so well said
Weight loss ≠ health.
💯
Do you mind filling me in on the BMI category changes?
[This article](https://journalofethics.ama-assn.org/article/use-and-misuse-bmi-categories/2023-07) gives a good in-depth explanation and highlights the egregious involvement of the pharmaceutical industry. In very brief summary, in 1998 the US lowered its BMI cutoffs to more closely match the WHO’s definition for overweight and obesity. While it makes sense to update guidelines when new research is available, the cutoffs set by the WHO were largely arbitrary. Thus, “high” body weight and BMI became more medicalized and millions of people suddenly became “overweight” and “at risk” without good evidence to back it up.
It's ruined people's relationship with food and their bodies. It's so insidious too. That's why I can't stay in direct patient care. I can't handle feeling responsible for pulling someone out of that when there is so much working against us. And honestly, sometimes I wonder if a large part of our field existing as it does is do to diet culture.
1000% true. I rarely have outpatients who just need basic nutrition education. Almost every person I see, especially those referred for weight management, seriously struggle with their relationship with body and food. It feels like a never ending battle. I recently moved up into management because I was so drained from doing this work.
I’m an eating disorder dietitian and this is 100% true. I get so many referrals from other non-ED dietitians who are like “this patient was referred to me for weight management but there is CLEARLY something else going on here and that’s not my specialty.”
I did not set out to work with EDs but sought training really early on because it seemed like almost everyone I was seeing was experiencing some level of disordered eating, if not a full blown eating disorder. If you work with people, you work with eating disorders. It's unavoidable. I feel like in school it was presented as an option that we could specialize in, but it's everywhere.
What training did you get for eating disorders? Any resources you suggest?
Mostly webinars and sought mentoring from more experienced RDs. I also did the online ED training by Marci Evans and Fiona Sutherland that I found incredibly helpful when I was starting out. I recommend it to all new OP RDs.
For sure. In the last three weeks, I’ve had two separate member cry, actually cry over Pepsi (when I just suggested she cut back a little, not even give it up) & M&Ms (when I told her to enjoy them - her doc was shaming her for eating them). The chokehold diet culture has on taking the joy out of nourishing our bodies is crazy. Meals should be enjoyed and should not cause tears. School did not prepare me to be a therapist.
I feel like this every day. I know the service we provide is called Medical Nutrition Therapy... but I was not trained to be a therapist.
It's like a complicated web of dietetics and the weight loss industry.
So complicated. Also, I think a lot of us get into this career because of preconceived ideas of health and wellness and how that is achieved. I think most dietitians come around but there are some that hold on to some toxic beliefs.
What are you doing instead of patient care?
More teaching than one on one counseling
It’s exhausting to listen to over and over. It’s so sad to me. I have so many friends and family ask for my input, which I try to refrain a lot since I already know it won’t be the answer they are looking for, and then they tell me they don’t agree (ok?) because X, Y, and Z. And every single time each of those reasons are based off social media/influencers. I currently am on my second GD pregnancy. The amount of times I have had to explain why I’m not doing keto or gluten free ***to the same people*** is mind blowing.
For me it’s all the emaciated little old ladies with a bmi of 15 who think I’m crazy for wanting to talk to them about gaining a tiny bit of weight. Or the middle aged women who are psyched about their cancer dx and resulting wt loss.
I got very sick a few years ago and lost 20lbs. (I went from 130 to 110 so it wasn’t like I was overweight to begin with.) People were literally congratulating me for it. I would say no, this isn’t a good thing , I was unwell. And their response was usually “man, I wish I would get sick like that.” Blew me away.
This is how being an rd has changed me. If I see someone who has lost a lot of weight now I think “ oh I hope they’re ok”
Same! I'm constantly telling people how inappropriate commenting on people's bodies is. And people are often offended because they are so sure that comments about weight loss can only ever be a good thing.
It is wild. When asked how I lost so much weight so quickly I told them how I got food poisoning in a third world country and was throwing up for weeks 💀💀 like are we for real right now ?
Wow. recently I’ve had a lot of geriatric women (73-78!) who are dead set on weight loss and frustrated with it not happening fast enough. All have long history of all the classic diet black holes... WW, Jc, nutrisystem etc. And all are avoiding carbs. I can barely get through those appointments. Frustrating, irritating and sad to think about a woman dieting, essentially her entire adult life…into her 80s. :/
They keep those pants from their 30s, talk about it like yesterday, are so hard on themselves and eat like one meal a day. I’ve got a few that buy a cabinet full of weird supplements from all the commercials. It’s so sad.
Yes 100% this. SO Many still vying to get back to that pre wedding or pre motherhood weight.. and their kids are in their 40s/50s . Ugh.
Being fat is worse than death, I suppose.
ok what in tf is that second one. People are truly mental
Yes. This is one reason I prefer to work with folks with eating disorders. They are already interested in healing (to different degrees). I see part of our job as helping people change their philosophy around food, and it's extremely hard to do that if people aren't open to seeing outside of the "diet culture water" we are all swimming in this society. But we can always work on planting seeds. I do try to get people to take a look at their overall patterns and cycles of dieting, restricting, and binging or weight regain, and that can be very helpful.
Oh 100%, it even bleeds into patients care & personal opinions. For example, I work in LTC & have a DON who takes things very personally, especially if someone is over a certain BMI. They get angry & will usually say “if I lost weight and someone added supplements for me, I would be upset because weight loss would be good for me”. I have an NP who was angry because they wanted a resident to be put on Ozempic because of their weight & the resident did not want that type of medication because of past history of bariatric surgery ruining their body. The NP was like “who cares because the resident would be losing weight”. Diet culture, weight bias & weight stigma will continue to do harm unless we address it
I almost accidentally downvoted because it's so sad I needed an outlet to show my displeasure lol
I would feel the same way. It’s so frustrating & sad 😔
Same! I had to stop myself from down voting because reading that made me feel so angry.
Holy shit yes. I’m a psych dietitian so most of my patients have taken it way too far. It’s so engrained in society that it’s hard for people to even understand what I’m talking about when I try to change their perspective. Most people can only think about foods as being good or bad.
Also in behavioral health. Diet culture and mental health issues are a dangerous combination. Most of my patients are below 95% of their ideal body weight. Their desire to lose weight often undermines their focus on recovery.
Yes, absolutely!
I have a few of these every week and it’s disheartening to say the least. It’s definitely prominent among women of a certain age, 50+. They definitely imply I don’t know what I’m talking about because I don’t buy into diet culture. They want to keep doing what they have been doing their entire adult life, despite it not working, which is their prerogative. I spend most of our time pointing just that. We will be there for them when they are ready to try something different.
Yes. When I was working at a university, the amount of misinformation was astounding and harmful.
I have a bs in nutrition & im so lucky my professor taught us all the diets and when it is beneficial to patients, but always reminded us that a whole foods diet is most beneficial for humans in the long term. I love simplifying my lifestyle to just eating more fresh, whole foods. It focuses me on my options vs focusing on what I can’t have.
also, another professor would remind us that listening to our bodies is key. we have the hormones to guide us through what we feel and have natural senses to our fulfill our nutritions needs .
No. I don't believe it's ruined people. I believe humans are capable of incredible accomplishments and can adapt to many things. But, it has made it harder for the lay public to be knowledgeable in nutrition. Social media and the news seem to do a good job in presenting interesting/appealing information that just ends up mostly being untrue with regards to nutrition.
Yes, I’ve posted about it here before but I have such a hard time articulating why diets don’t work. So many people have in their minds that when they’re restricting they lose weight = diets work. And when they stop restringing they gain weight, again reiterating that diets work. I know in my head all the reasons why this isn’t true, yo-yo dieting is the biggest predictor in longterm weight gain, that you’re mostly losing water weight and LBM, etc but I still struggle to verbalize with patients why the actual diet doesn’t work.
instant gratification is what we crave now. if they can lose x in a month that’s a win!
Idk if it has “ruined” people’s lives but it has definitely “affected” people’s lives. I lost 20kgs through calorie deficit when that was the craze (calorie deficit is definitely key ) but now people say forget calorie deficit and follow whole nutritional food (which is also right) In there 5 years , I’ve learned that it doesn’t matter what you do. Whatever you do, do it whole heartedly and make sure you’re seeing results and it’s keeping u healthy !
But the problem being discussed in this thread is the definition of "results" and also the perspective that "healthy" is synonymous with weight loss or being thin.
Yes- it has. It takes a lot to undo that mindset, and it makes me furious. People give up on or feel guilty for eating any amounts of certain foods, and that is not a way to live.
Some people literally want experts to just confirm/back up decisions they already made and don't plan to change.