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Demystifying ‘diet culture’: Exploring the meaning of diet culture in online ‘anti-diet’ feminist, fat activist, and health professional communities
Abstract
Social aspects of dieting are discussed in the extant feminist literature. However, despite frequent use of the term ‘diet culture’ in online communities critical of weight-loss dieting and popular books about the harms of restrictive eating, academic studies have not yet investigated its meaning holistically. We used thematic analysis to examine how those in the broad ‘anti-diet movement’ have challenged norms representing ‘diet culture,’ and how the term can be used to unite feminist researchers, activists, and health professionals. One-hundred and eighteen online qualitative survey participants (94.92% female; 37.29% health professionals; 51.70% anti-diet activists; Mage = 36.67) characterised ‘diet culture’ as ‘health myths about food and eating,’ and a ‘moral hierarchy of bodies’ driven by ‘systemic and structural factors.’ Feminist researchers, activists, and health professionals can use ‘diet culture’ to challenge myths and misconceptions about dieting and health, as well as the broader systems and structures that perpetuate these myths.
... JFS conducts research on body image and eating disorder recovery, with a background in qualitative methods. Further, this research was undertaken from a social constructionist epistemological position, recognizing the power of sociocultural discourses related to appearance, weight, and health on the experiences of higher-weight people in society broadly as well as healthcare specifically [20][21][22]. These sociocultural discourses position weight as an accurate indicator of health that is within individual control, with lower body weights considered healthiest (i.e., "normal" weight body mass index) [20][21][22]. ...
... Further, this research was undertaken from a social constructionist epistemological position, recognizing the power of sociocultural discourses related to appearance, weight, and health on the experiences of higher-weight people in society broadly as well as healthcare specifically [20][21][22]. These sociocultural discourses position weight as an accurate indicator of health that is within individual control, with lower body weights considered healthiest (i.e., "normal" weight body mass index) [20][21][22]. ...
... Invalidation occurred when patients' personal accounts of their illness were dismissed or not taken seriously, as described in the Lack of Patient Centered Care sub-themes. While many participant experiences of medical gaslighting can also be regarded as experiences of weight stigma, these themes were differentiated by whether or not participants reported they were dismissed or silenced, consistent with the definition of gaslighting [21]. ...
Background
As a rare endocrine disorder, Cushing’s Syndrome (Cushing’s) is characterized by numerous symptoms and a non-specific presentation, leading to a delay to diagnosis for patients with this disease. To date, research examining the lived experiences of patients with Cushing’s in healthcare is absent in the literature. This preliminary inquiry into the healthcare experiences of women with Cushing’s aimed to examine the utility of this line of inquiry to support the patient centered care of individuals with Cushing’s.
Methods
Seven women from across Canada with endogenous Cushing’s participated in the study. Semi-structured interviews were conducted examining participants’ healthcare and body-related experiences with Cushing’s. Results pertaining to healthcare experiences were analyzed for the current study using reflexive thematic analysis.
Results
Four themes emerged whereby women with Cushing’s experienced (1) a lack of patient centered care, characterized by provider miscommunication and medical gaslighting; (2) a misunderstanding of their symptoms as related to weight gain; (3) weight stigma in healthcare encounters; and (4) a shift in their quality of care following diagnosis.
Conclusions
The results highlight the importance of patient centered care as well as the negative impact of commonly reported barriers to patient centered care. Cushing’s specific barriers to patient centered care may include weight stigma as well as the rare incidence of Cushing’s. Further research is needed to better understand the healthcare experiences of people with Cushing’s in Canada.
... The term diet culture refers to the structural factors that support and maintain dieting behaviours-principally among women-in their social context. It is viewed as deriving from systems such as patriarchy and capitalism (Jovanovski & Jaeger, 2022a, 2022b, and is characterised by health myths about food and eating, as well as a moral hierarchy of bodies that gives preference to thinness over other body shapes and sizes (e.g., Faw et al., 2021;Jovanovski & Jaeger, 2022a). Within this system, thinness is seen as a marker of moral superiority, and a normative, healthy physiological state. ...
... The term diet culture refers to the structural factors that support and maintain dieting behaviours-principally among women-in their social context. It is viewed as deriving from systems such as patriarchy and capitalism (Jovanovski & Jaeger, 2022a, 2022b, and is characterised by health myths about food and eating, as well as a moral hierarchy of bodies that gives preference to thinness over other body shapes and sizes (e.g., Faw et al., 2021;Jovanovski & Jaeger, 2022a). Within this system, thinness is seen as a marker of moral superiority, and a normative, healthy physiological state. ...
... Immersion in diet culture affects how individuals view themselves, particularly in terms of social comparison. Jovanovski and Jaeger (2022a) found that disdain for diet culture can motivate women's rejection of disordered eating and beliefs around food. Such challenges can be understood as fundamentally feminist critiques. ...
This paper explores how the self-beliefs of women who have rejected weight-loss diet culture inform their strategies of resistance. We conducted a qualitative survey inviting participants to share methods they have used to challenge diet culture. One hundred and twelve women ( M age = 37.01, SD = 10.54) provided complete responses. Most were heterosexual (72%) and resided in Australia (59%). Our thematic analysis generated two themes: “diet culture is internalised, dismantling it is personal,” which was characterised by participants’ self-beliefs or self-identification, and the personal strategies they used to counter diet culture; and “diet culture is social, relationships are sites of resistance,” which reflected participants’ beliefs about the source of personal worth, as well as relational strategies they enacted in their personal and professional lives, and in their interactions with authority figures. Efforts to assist women in challenging diet culture could be strengthened by recognising the implications of immersion in such a culture for an individual's relational self and their perceptions of self-worth, and by harnessing the power of women's relationships with each other. This paper contributes to the feminist psychological literature on women's inequalities and their relationships with food and their bodies, illuminating connections between activism, healthcare, and everyday experience.
... Many researchers have highlighted how this has produced a contemporary "diet culture" (Foxcroft 2011;Jovanovski 2017). In this text, we understand dieting as any form of food restrictions with the goal of losing weight and "diet culture" as the normative discursive framework that values the slim, fit body and equates such body size to health and moral virtue (Jovanovski and Jaeger 2022;Madrone 2022). Furthermore, this normative framework attributes value to different foods and eating practices as a way to produce moral and social status. ...
... These areas of resistance emerge from the cultural meanings of fat and from personal experiences of having a non-normative body size (Lupton 2013). Many online health and dieting communities, especially those associated with IE, use the term "diet culture" to criticize contemporary dieting norms characterized by food restrictions and prohibitions and the pursuit of a slim body (Jovanovski and Jaeger 2022). ...
... Paradoxically, research on IE describes it as a new weight-loss paradigm, which combats overeating by focusing on physical or biological rather than emotional hunger (Gast and Hawks 1998). In more recent work, IE and other contemporary approaches are analyzed as part of an ongoing movement to create more confident relationships with food (Faw et al. 2020;Jovanovski and Jaeger 2022). Such an approach nevertheless overemphasizes an individualized bodily control with too little consideration of societal structures in which our ideas and practices of health are formed (Schwartzman 2015). ...
Our bodies and food consumption are increasingly becoming markers of social identity in contemporary societies. We often participate in "diet culture" by monitoring and controlling our food intake through eating restrictions and physical exercise to keep a bulging body in check. This contemporary "diet culture" has been criticized for embodying impossible fitness ideals and producing a pathological obsession with food. In this article, we will analyze the growing contemporary phenomenon of intuitive eating (IE) as an alternative to diet culture and explore how it is explained, promoted, and legitimized on the social media platform TikTok. By using the Foucauldian concept of self-transforma-tive practices, we illustrate how self-discipline is performed by IE content creators. The analysis shows that the IE approach is psy-chologized as part of a therapeutic discourse and, at the same time, it is a way for young women to resist the "diet culture" to become empowered in their self-transformation. The analysis illustrates how the IE approach can be understood as a part of a self-transformative project, and how achieving the position as an "intuitive eater" requires an increase in self-awareness. As such, we argue that the content creators produce a specific psycholo-gized discourse of hunger and an affectively-disciplined subject, all represented as "freedom from diet culture. "
... Diet Culture. Diet culture is a type of societal norm that classifies thin bodies as righteous and superior and large bodies as immoral and inferior [1]. Myths about food and health are also characteristic of diet culture, such as the false belief that an individual's weight is synonymous with-and a direct representation of-their health [1]. ...
... Diet culture is a type of societal norm that classifies thin bodies as righteous and superior and large bodies as immoral and inferior [1]. Myths about food and health are also characteristic of diet culture, such as the false belief that an individual's weight is synonymous with-and a direct representation of-their health [1]. Diet culture, along with other environmental factors (e.g., social support, familial context) [2], influences the development and maintenance of eating disorders (EDs). ...
... Weight Stigma Concerns. In addition to contributing to EDs, diet culture reinforces weight stigma [1]. Weight stigma includes negative attitudes, stereotypes, and discrimination that devalue individuals in larger bodies (e.g., believing that people in larger bodies are lazy) [5,6]. ...
Diet culture is a societal norm that ranks thin bodies as superior to other body types and has been associated with negative outcomes, such as eating disorders. Wellness has evolved into a term that is often used to promote diet culture messages. One possible way to combat diet culture is through single-session, digital mental health interventions (DMHIs), which allow for increased access to brief public health treatments. The framing of DMHIs is critical to ensure that the target population is reached. Participants (N = 397) were enrolled in a single-session DMHI, which was framed as either a Diet Culture Intervention (n = 201) or a Wellness Resource (n = 196). Baseline group differences in eating disorder pathology, body image, weight stigma concerns, fat acceptance, and demographic characteristics were analyzed. Across groups, participants reported moderately high eating disorder pathology, low-to-moderate levels of body dissatisfaction, moderate levels of fat acceptance, and either very low or very high weight stigma concerns. Participants in the Diet Culture Intervention group reported higher levels of fat acceptance than those in the Wellness Resource group (p < 0.001). No other framing group differences were identified, though post hoc analyses revealed differences based on recruitment source (i.e., social media versus undergraduate research portal). This study found that framing a DMHI as targeting diet culture or as a Wellness Resource can result in the successful recruitment of individuals at risk of disordered eating. Framing a DMHI as a Wellness Resource may increase recruitment of individuals with low levels of fat acceptance, which may be particularly important for dismantling diet culture, disordered eating, and weight stigma concerns. Future research should assess DMHI framing in other populations, such as men and adolescents.
... In this cultural context, body dissatisfaction is so commonplace that it has been referred to as a "normative discontent" (Rodin et al., 1984). For many, this normative discontent leads to weight loss and weight control efforts, the pervasive presence of which is referred to as "diet culture" in blogs and books by individuals in the anti-diet movement (Jovanovski & Jaeger, 2022). Diet culture, characterized in part by a preference for thin bodies, moralization of weight and a belief that thinness represents good health (Jovanovski & Jaeger, 2022), permeates all aspects of our lives, including health promotion efforts in schools that seek to "improve" the health of children and youth via a focus on body weight. ...
... For many, this normative discontent leads to weight loss and weight control efforts, the pervasive presence of which is referred to as "diet culture" in blogs and books by individuals in the anti-diet movement (Jovanovski & Jaeger, 2022). Diet culture, characterized in part by a preference for thin bodies, moralization of weight and a belief that thinness represents good health (Jovanovski & Jaeger, 2022), permeates all aspects of our lives, including health promotion efforts in schools that seek to "improve" the health of children and youth via a focus on body weight. ...
Weight-neutral approaches emphasize improving individuals’ relationships with food and prioritizing emotional and physical well-being over the pursuit of a lower weight as well as support the reduction of stigma experienced by persons with larger bodies. Discourse about health in schools needs to consider students of all sizes as well as the complexities of the relationship that individuals develop with their bodies. A comprehensive school health (CSH) approach is fundamental to ensuring well-being for every body, including teachers and school staff. We offer concrete suggestions for approaching health discourse from a weight-neutral lens, thus optimizing the health of the entire school community.
... Dieting thus becomes about the numbers, whether they are the pounds on scale, the inches on the waistline, or the hours spent fasting between eating windows. Diet industry discourse focuses our attention on aesthetics, often disguised as a way to attain health or wellbeing, to drive self-surveillance and weight-management behaviours (Jovanovski & Jaeger, 2022). This means that how the body looks to self and others becomes the benchmark by which good eating behaviours are judged. ...
... Although all genders are subject to weight management concerns, the diet industry tells us that women, especially, need to pay attention to their weight (Jovanovski & Jaeger, 2022). More generally, women are socialized to contain and internalize the effects of exposure to stressors, whereas men are socialized to externalize and act upon the stressor (Rosenfield, 2000). ...
Objective: That we all weigh something is a fact of life, yet the material reality of weight is refracted through multiple layers of surveillance revealing contradictions in experience and understanding, depending on one’s vantage point. We explored the complexities of weight with the specific aim of furthering understanding of this multifaceted surveillance.
Methods and Measures: We used hermeneutics, the philosophy and practice of interpretation, as the method of inquiry. Ten experts by experience and seven professional experts participated in interviews, which were audio- recorded, transcribed, and analyzed. Interpretations were developed through group discussions among the eight authors and reiterative writing.
Results: Using the metaphor of optics, we demonstrate how the interplay of the panopticon (the few watching the many) and synopticon (the many watching the few) help us gain a deeper understanding of weight through “fitting in,” being “captured by numbers,” “dieting: the tyrannic tower,” and “the male gaze.”
Conclusion: Monitoring and judging body weight have become so normative in Western society that “weight watching” practices are synonymous with good citizenship and moral character. This study offers insight about how weight is conceptualized in personal and professional contexts, with implications for body image, dieting, eating disorders, public health, and weight bias.
... Despite this theme of speaking positively of motherhood and the shared experience of wanting to care for their child, these results also bring forward the issue of the glorification of thinness and moralization of larger bodies. This finding speaks to the implicit power that holds smaller or thin body ideals as a goal all women should strive for [40], and pregnancy as the only time where it would be acceptable to do otherwise. Moreover, women of colour in this sample articulated that their bodies may gain weight differently from White bodies, yet our body ideals even in pregnancy come from predominantly Western ideologies. ...
Weight stigma is a social justice issue that can lead to weight-based discrimination and mistreatment. In pregnancy, emerging evidence has highlighted that weight stigma predominantly affects individuals who have larger bodies and is associated with postpartum depression and avoidance of healthcare. Racial and ethnic background will influence perceptions of, and responses to, weight stigma and therefore it is necessary to ensure diverse voices are represented in our understanding of weight stigma. Semi-structured interviews were conducted with ten women who were within one year postpartum; nine identified as Black or African American and one as Hawaiian. Thematic analysis led to identification of three themes: (1) sources of weight stigma and their response to it, (2) support systems to overcome weight stigma, and (3) intersectional experiences. Women reported that sources of weight stigma included unsolicited comments made about their weight often coming from strangers or healthcare professionals that resulted in emotional distress. Support systems identified were family members and partners who encouraged them to not focus on negative remarks made about weight. Intersectional accounts included comparing their bodies to White women, suggesting that they may carry their weight differently. Women shared that, although they felt immense pressure to lose weight quickly postpartum, motherhood and childcare was their utmost priority. These findings inform further prospective examination of the implications of weight stigma in pregnancy among diverse populations, as well as inform inclusive public health strategies to mitigate weight stigma.
... The extent to which the literature on internalized weight stigma is framed alongside obesity, weight loss, and weight control is concerning, as it highlights a weight-centric approach to research that may unintentionally reinforce sociocultural discourses about weight and health, also known as diet culture. Diet culture is defined as encompassing: (1) food and eating myths that moralize food choices; (2) myths that weight is a reliable proxy for health; (3) a moral hierarchy of bodies in society that idealize thinness and demonize fatness; and (4) connections to other forms of systemic oppression, including racism, patriarchy, and capitalism [43]. This definition of diet culture is consistent with what Rodgers [44] described as "healthy weight discourse". ...
Background
Since the first papers focused on internalized weight stigma were published in the mid 2000’s, the literature has grown into a robust field that complements existing knowledge on weight stigma. Recently, researchers have documented the need for increased conceptual and measurement clarity, to distinguish internalized weight stigma from body dissatisfaction. Although several systematic reviews have been conducted on portions of the internalized weight stigma literature, no review to date has been conducted examining the entirety of the literature.
Objective
The aim of this research was to conduct a systematic scoping review and synthesis of research on internalized weight stigma. Specifically, we sought to examine the broad scope of the literature, terms used to refer to internalized weight stigma, how internalized weight stigma is defined, sample characteristics, and weight-based framings of internalized weight stigma research.
Methods
We conducted a single-concept search across six databases (EMBASE, Medline, PsychINFO, PubMed, SCOPUS, and Web of Science) of peer-reviewed papers published in English on internalized weight stigma. Data were extracted for article authors, year published, journal name and type, general article topic(s), study design, study location, sample characteristics, variables measured, paper framing, term used to describe internalized weight stigma, and definition of internalized weight stigma.
Results
Of the 931 unique records screened, 376 were identified for inclusion in the scoping review. The majority of internalized weight stigma research is characterized by cross-sectional methods, has been conducted in the US, and has utilized samples of higher weight white women. Further, 40 unique terms were used across the literature to refer to internalized weight stigma, and 19 different components of definitions of internalized weight stigma were identified. The literature is also characterized by a focus on understanding the association between internalized weight stigma and health outcomes with an emphasis on obesity.
Conclusions
This scoping review confirms a lack of concept clarity of internalized weight stigma, in part influenced by an inconsistency in definitions of internalized weight stigma across the literature. Considerations are provided for steps to enhance conceptual and measurement clarity. Given the obesity focused framing of much of the research on internalized weight stigma, considerations are also provided for reducing weight-centric approaches to research.
Plain english summary
In the early 2000’s, researchers began to pay more attention to the potential health impacts of believing societal stereotypes, negative attitudes, and beliefs about higher weight people. When these stereotypes, negative attitudes, and beliefs are directed towards the self, it can have significant consequences for an individual’s perceptions of self. This research collected and summarized all existing research published in English on internalized weight stigma. Our results highlighted that researchers do not use consistent terminology to refer to internalized weight stigma and that they do not have a consistent definition of internalized weight stigma. Further, a large proportion of the research is focused on obesity or weight loss, which may unintentionally perpetuate weight stigma in scientific research. We provide several recommendations for researchers to address these challenges in future research on internalized weight stigma as well as recommendations to address other identified gaps in the existing literature.
... Meanwhile, an increasing number of nutrition professionals attribute concerns about consuming UPFs to fearmongering and "diet culture", representing "myths" about food and eating [10]. Efforts to "debunk" concerns about how UPFs interact with homeostatic hunger can be well intentioned with the important goal of ED prevention. ...
Ultra-processed foods (UPFs) like pastries, packaged snacks, fast foods, and sweetened beverages have become dominant in the modern food supply and are strongly associated with numerous public health concerns. While the physical health consequences of UPF intake have been well documented (e.g., increased risks of cardiometabolic conditions), less empirical discussion has emphasized the mental health consequences of chronic UPF consumption. Notably, the unique characteristics of UPFs (e.g., artificially high levels of reinforcing ingredients) influence biological processes (e.g., dopamine signaling) in a manner that may contribute to poorer psychological functioning for some individuals. Importantly, gold-standard behavioral lifestyle interventions and treatments specifically for disordered eating do not acknowledge the direct role that UPFs may play in sensitizing reward-related neural functioning, disrupting metabolic responses, and motivating subsequent UPF cravings and intake. The lack of consideration for the influences of UPFs on mental health is particularly problematic given the growing scientific support for the addictive properties of these foods and the utility of ultra-processed food addiction (UPFA) as a novel clinical phenotype endorsed by 14–20% of individuals across international samples. The overarching aim of the present review is to summarize the science of how UPFs may affect mental health, emphasizing contributing biological mechanisms. Specifically, the authors will (1) describe how corporate-sponsored research and financial agendas have contributed to contention and debate about the role of UPFs in health; (2) define UPFs and their nutritional characteristics; (3) review observed associations between UPF intake and mental health conditions, especially with depression; (4) outline the evidence for UPFA; and (5) describe nuanced treatment considerations for comorbid UPFA and eating disorders.
... The ubiquitous nature of social media facilitates constant exposure to curated images portraying unattainable body standards, fostering a culture of comparison and dissatisfaction with one's own appearance [4]. Furthermore, the normalization of extreme dieting practices and the glorification of thinness within online communities can contribute to the development of disordered eating behaviors [5]. Additionally, a 2018 meta-analysis found that body checking and body image avoidance lead to EDs [6]. ...
Eating disorders and body image concerns are increasingly prevalent issues among young individuals, with medical students being particularly vulnerable due to heightened stress levels. This study enrolled 879 medical students to investigate these concerns. The KomPAN questionnaire was utilized to assess dietary habits and knowledge, the Body Esteem Scale (BES) to evaluate body satisfaction, and The Eating Attitudes Test (EAT-26) to identify eating disorders. A higher level of nutritional knowledge was found to be statistically significantly associated with attempts at excessive calorie restriction among women (β = 0.0864) and negatively among men (β = −0.2039). Moreover, it was negatively associated with self-control of food intake only among men (β = −0.2060). Furthermore, a higher BMI was associated with attempts of excessive calorie restriction in both women and men (β = 0.1052 and β = 0.1656, respectively) and negatively with self-control of food intake (β = −0.0813 and β = −0.1453, respectively). A higher BMI was associated with poorer body esteem across all variables in both genders, except for upper body strength among men. Nutritional knowledge did not correspond with any of these variables, while dietary quality was positively associated with physical condition in women and with physical condition, physical attractiveness, and upper body strength in men. Our study findings suggest that dietary interventions could be improved by considering gender-based behavioral differences and focusing on portion control for individuals with a higher BMI. Caution is warranted in extrapolating the results to the general population due to the specific nature of the study population.
... Well-being needs to consider elements like gender. So much of our well-being program tries to distance the concepts and practices of wellness from the overwhelmingly monetized and gendered world of the wellness industry, where women are often the targets of advertising and trends that are rooted in diet culture (Jovanovski & Jaeger, 2022), misogynistic and racist beauty standards (Gamby & Burns, 2021), and the coopting and appropriation of spirituality (Burton, 2020). While these problematic links between what people call "well-being" and gender were clear to me, I had not yet considered the impacts of gendered labour in terms of well-being in a fulsome way until the pandemic. ...
This chapter draws on an emerging well-being program at the School of Education, Trent
University, where I teach, to investigate how autoethnographical reflections correspond to theory
and pedagogy relevant to teacher identity, intersectionality, and care in the digital space. Blending
autoethnography with feminist, cultural, and pedagogical research, I argue that the online space
can be a site for communal connection and well-being, even and especially when it can also be a
source of stress and disconnection. Autoethnography brings together voice and experience to forge
connections between individuals and communities in a sometimes lonely world and, in particular,
in communities that are increasingly structured online (Atay, 2020; Calzati, 2020). We are just
beginning to understand the interstices and confluences of subjectivity, the digital landscape, and
communal connections. I explore the creation and sustainability of a well-being program at the
Trent School of Education that, due to the COVID-19 pandemic, was suddenly shifted online. I
bring together my own autoethnographical reflections during the pandemic, including my own
struggles with well-being while leading well-being sessions for teacher candidates. At a time of
unprecedented stress and concerns over health and well-being (Hamilton & Gross, 2021), I found
that our well-being program fostered a space for reflection and connection. Further, I realized that
using the online space, while creating stress for other kinds of work, was effective and even
preferable for well-being work and community connections
... While the term has yet to be broadly defined, the socially influenced dichotomization ("on" or "off " a diet) and rigid surveillance of food that is reflected in eating behaviors is often referred to as "diet culture". [5] Sport-specific dieting cultures are often cited in weight-class sports for reasons of regulation and tradition [1] as well as in aesthetic-sports if judges are influenced by a standard of thinness. [2] However, the thin ideal is also considered to be advantageous in endurance sports with common expressions such as "thin to win" or "runner's body" that associate a specific somatotype with enhanced aerobic performance. ...
Background
Frequent dieting is common in athletes attempting to achieve a body composition perceived to improve performance. Excessive dieting may indicate disordered eating (DE) behaviors and can result in clinical eating disorders. However, the current nutrition patterns that underly dieting culture are underexplored in endurance athletes. Therefore, the purpose of this study was to identify the sex differences in nutrition patterns among a group of endurance athletes.
Methods
Two-hundred and thirty-one endurance athletes (females = 124) completed a questionnaire regarding their dieting patterns and associated variables.
Results
The majority of athletes did not follow a planned diet (70.1%). For endurance athletes on planned diets (n = 69), males were more likely follow a balanced diet ( p = 0.048) and females were more likely to follow a plant-based diet ( p = 0.021). Female endurance athletes not on a planned diet (n = 162) were more likely to have attempted at least one diet ( p < 0.001). Male athletes attempted 2.0 ± 1.3 different diets on average compared to 3.0 ± 2.0 for females ( p = 0.002). Female athletes were more likely to attempt ≥ three diets ( p = 0.022). The most common diet attempts included carbohydrate/energy restrictive, plant-based, and elimination diets. Females were more likely to attempt ketogenic ( p = 0.047), low-carbohydrate ( p = 0.002), and energy restricted diets ( p = 0.010). Females made up the entirety of those who attempted gluten-/dairy-free diets (F = 22.0%, M = 0.0%).
Conclusions
Being a female athlete is a major determinant of higher dieting frequency and continual implementation of popular restrictive dietary interventions. Sports dietitians and coaches should prospectively assess eating behavior and provide appropriate programming, education, and monitoring of female endurance athletes.
El concepto de comunidad es ampliamente utilizado en las ciencias sociales, pero
su uso polisémico y general puede limitar la comprensión de realidades sociales
complejas. Este artículo presenta una reflexión sobre el concepto de comunidad a partir
de un análisis sistemático de su uso en la literatura académica de 2022. Se priorizaron
2430 artículos académicos y se analizaron 7 categorías conceptuales donde se
evidencia una diversidad de enfoques y perspectivas, pero también una falta de claridad conceptual y una falta de atención a la simetría de los actores humanos y no humanos en la construcción de comunidades.
In this introductory chapter, I explore diet culture, including its sexual politics, the statistics underpinning its existence, and the notion of a ‘diet counterculture’. In doing so, I argue for the importance of understanding what unifies women in the fragmented and diverse ‘anti-diet movement’, and discuss the type of methodology I used in this project (e.g., feminist methodologies), my influences and how they have informed the development of this project, as well as the theoretical perspectives the monograph has been grounded in (e.g., Bourdieu’s theory of practice). I finish the introduction with a brief overview of the chapters to come.
Objective: Body image issues are common among young adult women on college campuses and are correlated with several negative outcomes. Only recently have universities begun to deliver Health at Every Size (HAES) education to university students to promote holistic health. Method: A sample of students who attended events for Body Appreciation Week (BAW) 2022 (N = 42) completed a Qualtrics survey collected by a student health promotion department at a large, southeastern university. I used this data to assess student openness to HAES and other alternatives to weight-centric approaches to health. Results: Overall, students who responded to the survey were pleased with programming that challenged diet culture and introduced the HAES model of health. Conclusion: Student feedback, along with previous research on college student programming interventions, suggests organizing similar events for future BAW and more frequent programming during the academic year to properly assess of the impact of these events on student health.
Background
Poor body image is prevalent among adolescents and associated with several negative outcomes for their physical and psychological health. There is a pressing need to address this growing public health concern, yet there are few evidence-informed universal programmes for older adolescents that address contemporary body image concerns (i.e., social media). BodyKind is a four lesson, school-based, teacher led, universal body image programme that incorporates empirically supported principles of cognitive dissonance, self-compassion, compassion for others and social activism, to support positive body image development. Building on previous pilot trials in the USA, this paper outlines the protocol for a cluster randomised control trial (cRCT) and implementation evaluation of the BodyKind programme which was culturally adapted for the Irish cultural context.
Methods
We aim to recruit 600 students aged 15-17 years in Transition Year (4th year) across 26 second-level schools in Ireland. Using minimisation, schools will be randomly assigned to receive BodyKind (intervention condition, n=300) or classes as usual (waitlist control, n=300). Teachers in intervention groups will receive training and deliver the programme to students over four weeks, at a rate of one lesson per week. Primary outcomes of body appreciation, body dissatisfaction and psychological wellbeing and secondary outcomes of self-compassion, compassion for others, body ideal internalisation, social justice motives and appearance-based social media use will be assessed at pre-, post- and 2 month follow up. Mediation and moderation analyses will be conducted to identify how and for whom the intervention works best. An implementation evaluation will assess the quality of programme implementation across schools and how this may influence intervention outcomes. Waitlist control schools will receive the programme after the 2-month follow up.
Conclusion
This study will be the first to implement a cRCT and an implementation evaluation to assess the impact of this multicomponent school-based body image programme designed to support healthy body image development. If shown to be effective, BodyKind will have the potential to improve adolescent body image and wellbeing and inform efforts to implement sustainable and scalable programmes in schools.
Trial registration
The trial was retrospectively registered on 10/10/2023 on ClinicalTrials.gov NCT06076993.
Background
Weight‐loss attempts are widespread in the United States, with many using commercial weight‐loss diet plans for guidance and support. Accordingly, dietary suggestions within these plans influence the nation's food‐related environmental footprint.
Methods
We modelled United States (US) per capita greenhouse gas emissions (GHGe) and water footprints associated with seven commercial weight‐loss diets, the US baseline, and selected other dietary patterns. We characterised consumption in commercial weight‐loss diets both via modelling from provided guidelines and based on specific foods in 1‐week meal plans. Cradle‐to‐farmgate GHGe and water footprints were assessed using a previously developed model. GHGe results were compared to the EAT‐Lancet 2050 target. Water footprints were compared to the US baseline.
Results
Weight‐loss diets had GHGe footprints on average 4.4 times the EAT‐Lancet target recommended for planetary health (range: 2.4–8.5 times). Bovine meat was by far the largest contributor of GHGe in most diets that included it. Three commercial diets had water footprints above the US baseline. Low caloric intake in some diets compensated for the relative increases in GHGe‐ and water‐intensive foods.
Conclusions
Dietary patterns suggested by marketing materials and guidelines from commercial weight‐loss diets can have high GHGe and water footprints, particularly if caloric limits are exceeded. Commercial diet plan guidance can be altered to support planetary and individual health, including describing what dietary patterns can jointly support environmental sustainability and weight loss.
Weight stigma, defined as pervasive misconceptions and stereotypes associated with higher body weight, is both a social determinant of health and a human rights issue. It is imperative to consider how weight stigma may be impeding health promotion efforts on a global scale. The World Obesity Federation (WOF) convened a global working group of practitioners, researchers, policymakers, youth advocates, and individuals with lived experience of obesity to consider the ways that global obesity narratives may contribute to weight stigma. Specifically, the working group focused on how overall obesity narratives, food and physical activity narratives, and scientific and public‐facing language may contribute to weight stigma. The impact of weight stigma across the lifespan was also considered. Taking a global perspective, nine recommendations resulted from this work for global health research and health promotion efforts that can help to reduce harmful obesity narratives, both inside and outside health contexts.
Background
Poor body image is prevalent among adolescents and associated with several negative outcomes for their physical and psychological health. There is a pressing need to address this growing public health concern, yet there is a lack of evidence-informed universal programmes for older adolescents that address contemporary body image concerns (i.e., social media). BodyKind is a four lesson, school-based, teacher led, universal body image programme that incorporates empiricallysupported principles of cognitive dissonance, self-compassion, compassion for others and social activism, to support positive body image development. Building on previous pilot trials in the USA, this paper outlines the protocol for a cluster randomised control trial (RCT) and implementation evaluation of the BodyKind programme which was culturally adapted for the Irish cultural context.
Methods
We aim to recruit 600 students aged 15–17 years in Transition Year (4th year) across 26 second-level schools in Ireland. Using minimisation, schools will be randomly assigned to receive BodyKind (intervention condition, n = 300) or classes as usual (waitlist control, n = 300). Teachers in intervention groups will receive training and deliver the programme to students over four weeks, at a rate of one lesson per week. Primary outcomes of body appreciation, body dissatisfaction and psychological wellbeing and secondary outcomes of self-compassion, compassion for others, body ideal internalisation, social justice motives and appearance-based social media use will be assessed at pre-, post- and 2 month follow up. Mediation and moderation analyses will be conducted to identify how and for whom the intervention works best. An implementation evaluation will assess the quality of programme implementation across schools and how this may influence intervention outcomes. Waitlist control schools will receive the programme after the 2-month follow up.
Conclusion
This study will be the first to implement a cRCT and an implementation evaluation to assess the impact of this multicomponent school-based body image programme designed to support healthy body image development. If shown to be effective, BodyKind will have the potential to improve adolescent body image and wellbeing and inform efforts to implement sustainable and scalable programmes in schools.
Trial registration
The trial was retrospectively registered on 18/07/2023 on the OSF registry [osf.io/nhje4]]
Type 2 diabetes is prevalent among Black Americans. Stigma associated with type 2 diabetes, both in general and specific to weight, is damaging to self-care, which is crucial for the effective management of diabetes. Family relationships may buffer the negative impact of stress, especially among Black Americans who have historically relied on informal support networks. Our goal was to investigate how type 2 diabetes stigma (H1) and weight stigma (H2) were related to self-care and intuitive eating – a non-restrictive approach to nutrition; H3 predicted that family relationship satisfaction would moderate the relationships predicted in H1 and H2. Black Americans diagnosed with type 2 diabetes (N = 225) were recruited via Qualtrics panels to complete an online survey of self-report measures. We used multiple linear regression to test our hypotheses. Both chronic illness and weight stigma were related as predicted to one subscale of intuitive eating (eating for physical hunger). Our moderation analyses revealed that family relationship satisfaction was protective against the harms of stigma at moderate to high levels. Intuitive eating is a promising non-restrictive treatment option for type 2 diabetes.
Individuals seeking support or inspiration for eating disorder recovery may turn to pro-recovery content on social media sites such as TikTok. While research has thus far treated pro-recovery social media as a fairly homogeneous space, many pro-recovery hashtags single out particular eating disorder diagnoses. This exploratory study used codebook thematic analysis of 241 popular pro-recovery videos on TikTok to compare the presentation of eating disorders and eating disorder recovery across five different diagnosis-specific hashtags: #anarecovery, #arfidrecovery, #bedrecovery, #miarecovery, and #orthorexiarecovery. These hashtags refer to the following eating disorder diagnoses respectively: anorexia nervosa, avoidant restrictive food intake disorder, binge eating disorder, bulimia nervosa, and orthorexia nervosa. Our analysis generated the following qualitative themes across the entire dataset: (1) centrality of food to eating disorders and recovery, (2) what eating disorders look and feel like, (3) recovery as a process, (4) getting and giving help, and (5) negotiating diet culture in recovery. To supplement our qualitative findings and facilitate cross-diagnostic comparisons, we also conducted one-way ANOVAs and chi-square tests to probe for statistically significant differences in audience engagement and code prevalence across the different hashtags. Our results indicate that there are clear differences in how recovery is envisioned on TikTok based on which diagnostic hashtags are employed. Such variations in how different eating disorders are imagined on popular social media demand further investigation and clinical consideration.
While eating disorders have been estimated to affect at least 4% of the Australian population, research demonstrates that feeding difficulties and eating disorders are overrepresented in neurodivergent people, including in autism, ADHD, intellectual disability, giftedness, and Tourette’s disorder. However, despite there being a substantial body of literature spanning decades evidencing links between neurodivergence and eating disorders, awareness among clinicians and researchers of this existing knowledge base is only emerging in Australia.
NEDC commissioned Eating Disorders Neurodiversity Australia (EDNA) to write a report, Eating Disorders and Neurodivergence: A Stepped Care Approach, that synthesizes research and lived experience evidence regarding the prevention, early identification and treatment of eating disorders and disordered eating for neurodivergent people.
This report aims to encourage collaboration among stakeholders to co-produce and co-design appropriate, effective, culturally valid, and safe neurodiversity-affirming support systems and care pathways. It is designed for the use of a wide range of stakeholders, especially health care professionals (e.g., psychiatrists, psychologists, dietitians, general practitioners, paediatricians, occupational therapists), researchers, academics, educators (e.g., teachers), service managers, and lived experience experts.
This report draws on fundamental constructs relating to human rights, bioethics, humanistic psychology, phenomenology, and social justice. It challenges traditional understandings of neurodivergence as pathological. It seeks to destigamtise neurodivergent body awareness and image, feeding, and eating experiences and behaviours. It is a call to action for all eating disorder stakeholders to engage in a radical rethink of how neuronormative feeding and eating practices, which influence research and clinical practice across all levels of eating disorder care, may prove harmful for neurodivergent people.
Feminist teaching methods, informed by the Women’s Liberation Movement, have played an important role in honoring and giving authority to the lived experiences of women under patriarchy. These methods have been particularly useful in the health sciences, which have traditionally been the site of androcentric ideas about health and the trivialization of women’s health concerns. However, in recent decades, women have entered the health sciences in greater numbers and incorporated their lived experiences as women into their “learned experiences” as health professionals. One notable example of the successful merging of women’s lived experiences under patriarchy, and their learned experiences in male-dominated health sciences, is the pedagogy and practice of weight-inclusive health professionals. This chapter discusses the origins of Women’s Studies, its significance to the Women’s Health Movement and its emergence in the health sciences, and the “anti-diet” movement as a contemporary example of women’s lived and learned experiences in improving women’s health. Overall, this chapter concludes by reflecting on the legacy of feminists and fat activists who inspired “anti-diet” health professionals, and on the future of the weight-inclusive health paradigm.
Objective:
Binge eating within binge-eating disorder (BED) is a behaviour widely understood as a response to dietary restraint and emotion dysregulation. However, qualitative literature suggests that a wider range of functions of binge eating exist, with associations between functions of binge eating and adverse childhood experiences highlighted across this research. The present study sought to develop a scale to measure a wide range of functions of binge eating within BED. A secondary aim was to examine the relationship between these functions and adverse childhood experiences (ACEs).
Method:
The researchers developed an initial item pool for the Functions of Binge Eating Scale (FBES) and invited experts within the eating disorder (ED) field (n = 22) to review the items. The refined item pool was administered online to adults with self-reported binge eating symptoms (N = 882), along with related measures to establish scale validity.
Results:
Exploratory and confirmatory factor analyses produced an eight-factor structure (emotion regulation, hedonic hunger, compensatory eating, numbness/dissociation, emotion expression, self-punishment, control, self-protection). The scale demonstrated good internal reliability and adequate construct and predictive validity. Results also showed that functions theoretically related to childhood maltreatment were predicted by ACEs.
Discussion:
Findings extend our understanding of the range of functions of binge eating experienced in BED. Additionally, findings indicate that type of adverse childhood experience predicts functions of binge eating. Initial validation of the FBES suggests that functions of binge eating are wider than previously understood. Accordingly, clinicians are encouraged to explore and target more complex processes which might perpetuate binge-eating behaviour.
The news media has consistently promoted weight loss as a solution to the “obesity epidemic”, despite research refuting the connection between fatness and health. In this paper, I examine the framing of weight loss in news articles during lockdown months of 2020, addressing whether healthist ideologies about weight loss persisted or declined during the pandemic. Most articles reflected a healthism lens, encouraging weight loss to achieve good health and to prevent COVID-19. However, some articles rejected weight loss or utilized a Health at Every Size perspective. This study has implications for research on body surveillance, neoliberalism, public health, and media reporting about weight loss and COVID-19.
Current healthcare is weight‐centric, equating weight and health. This approach to healthcare has negative consequences on patient well‐being. The aim of this article is to make a case for a paradigm shift in how clinicians view and address body weight. In this review, we (1) address common flawed assumptions in the weight‐centric approach to healthcare, (2) review the weight science literature and provide evidence for the negative consequences of promoting dieting and weight loss, and (3) provide practice recommendations for weight‐inclusive care.
Discussing health in many “body positive” spaces will provoke a variety of familiar responses, for example, “but it is possible to be both fat and healthy,” “thin people can be just as unhealthy as fat people,” and “what about health at every size?” While there are many different ways to interpret the Health at Every Size (HAES) movement , this article seeks to examine the links between Lindo Bacon’s Health at Every Size: The Surprising Truth about Your Weight and the popularized body positivity movement as it is today. While Bacon and other health professionals subscribed to HAES undoubtedly have good intentions, those intentions do not absolve the negative impact that the popularization of HAES-related body positivity has had on those of us who are both fat and, by the definition of HAES “unhealthy.” The rise of body positivity into mainstream consciousness has popularized an “acceptable” way to be fat and perpetuates the stereotype of the “good fatty.” Using autobiographical writing of fat women who have been associated with fat activism and body positivity, I draw lines between Bacon’s influential text and some of the healthism that exists in the body positivity movement. Inspired by my discomfort with the celebration of HAES in fat body positive spaces, I ask how does HAES promote healthism in the contemporary body positivity movement?
Weight-based oppression, including negative attitudes about body weight, and harassment, stigma, and discrimination based on body weight, is a widespread phenomenon that leads to considerable distress and poor health and wellbeing outcomes. Conversely, body positivity is a multi-faceted concept that encompasses body acceptance, body appreciation, and body love, and adaptive approaches protective of health and wellbeing. The aim of this study was to evaluate the impact of a brief health promotion activity informed by Health at Every Size® and critical health promotion principles on body positivity and internalized weight-based oppression in female students at Qatar University. A quasi-experimental mixed methods pre-post evaluation design was used, with quantitative assessment of body positivity and internalized weight-based oppression before the activity, immediately afterwards, and 10 weeks later, and qualitative assessment at the 10-week follow up. Measures used were the Body Appreciation Scale 2, Modified Weight Bias Internalization Scale, Fat Attitudes Assessment Toolkit Size Acceptance and Self Reflection on Body Acceptance subscales, and an open-ended questionnaire. Body acceptance and appreciation increased significantly after the activity. Qualitative results suggest that these improvements were sustained at follow up. Brief Health at Every Size® informed health promotion activities show potential to improve health and wellbeing.
Body dissatisfaction is pervasive among women in the United States. As a result, women feel pressured to participate in body‐related corumination. In response to evidence suggesting that diet culture and body‐related corumination can produce significant harm, scholars have increasingly proposed intuitive eating as a body‐positive alternative. This study explores the relationships between body‐specific corumination, body dissatisfaction, friendship quality, and intuitive eating. Results from this study's mixed‐methods investigation suggest that increased body‐related corumination is associated with increased body dissatisfaction and decreased intuitive eating. Relationship quality is associated with intuitive eating, and intuitive eating is negatively associated with body dissatisfaction. Results from this study's qualitative data indicate that women experience body‐related conversations in specific ways that can enforce unhealthy patterns of behavior and conversation.
Body positivity messages and practices are rapidly being spread transnationally, particularly in the form of digital activism, challenging oppressive body ideals and advocating for diversity and the acceptance of all body types. At the same time, however, the movement is increasingly being criticised for its commodification, how it goes hand in hand with neoliberalism and its lack of intersectional perspectives. This text investigates the potential of the expansion, redefinition and ‘repoliticising’ of body positivity beyond the white, neoliberal discourse. The analysis mainly dives into the texts and images of blogs by two body positive advocates, Leah Vernon and Stephanie Yeboah, who both identify as black and fat and who both address the issues of race and racism. It is suggested that through their body politics, they display how race and gender are intersected in the shaping of both body shaming and the production of ‘proud’ bodies, thus contributing to the situatedness of body positivity. The stance of being unapologetic in one’s body—a central element of body positivity—is regarded as being reframed through the contestation of the whiteness privilege and racism.
Purpose of review:
This narrative review summarizes literature on the stigma and prejudices experienced by individuals based on their weight in the context of romantic relationships.
Recent findings:
Individuals presenting with overweight or obesity, particularly women, are disadvantaged in the formation of romantic relationships compared with their normal-weight counterparts. They are also more prone to experience weight-based stigmatization towards their couple (from others), as well as among their couple (from their romantic partner). Currently available studies showed that weight-based stigmatization by a romantic partner was found to be associated with personal and interpersonal correlates, such as body dissatisfaction, relationship and sexual dissatisfaction, and disordered eating behaviors. Scientific literature on weight-based stigmatization among romantic relationships is still scarce. Prospective researches are clearly needed to identify consequences of this specific type of stigmatization on individuals' personal and interpersonal well-being. The use of dyadic designs could help to deepen our understanding as it would take into account the interdependence of both partners.
Eating disorders (EDs) are more common among younger women compared to older women and in women compared to men. As such, most ED research focuses on late adolescent and young adult females resulting in limited prospective research on gender differences in eating disorder psychopathology across the life span. The present study addresses this gap by examining gender differences in ED diagnoses, eating pathology, and the impact of putative risk factors on eating pathology in women (n = 624) and men (n = 276) over a 30-year period from late adolescence (M (SD) = 20[2] years) to later midlife (M (SD) = 50[2] years). Four assessment waves were conducted, beginning with baseline participation during college and subsequent 10-, 20-, and 30-year follow-up. Retention at 30-year follow-up was 72% (n = 440) for women and 67% (n = 181) for men. Prevalence of DSM–5 ED diagnoses decreased over the 30-year span for women and remained stable for men, with no significant gender difference in point prevalence by age 50. Drive for thinness decreased for women through age 50 and increased for men, while bulimic symptoms decreased as both genders aged. Multilevel models demonstrated that the impact of dieting as a risk factor on drive for thinness decreased prospectively as men aged and remained stable as women aged. Results imply that current risk models require refinement to account for developmental trajectories in which dramatic gender differences observed in late adolescence diminish over time.
This article used feminist fat studies as the theoretical rubric through which the author has offered a critical analysis of the representations of fat female characters in the two selected literary texts: Fatropolis (2012) by Tracey L. Thompson and They don’t make plus size spacesuits (2019) by Ali Thompson. Both these texts are set in alternative realities and offer sustained engagements with the ubiquitous and pernicious manifestations of fat phobia in the lives of female characters. Although these authors chose science fiction as a genre, no fat woman would be able to read the texts without wincing in recognition. From the fat phobic micro aggressions to the blatant violence and discrimination that shape daily fat lives, these texts offer our experiences writ large. The fat female body remains something of a blind spot in contemporary feminist studies, which is somewhat strange, considering the profound impact that fat, and the fear of becoming fat, has on the lives of women in almost every sphere of life. Diet culture, which is regarded as the capitalist commodification of fat phobia, is so rife and has become so normalised that most people have simply stopped noticing how their bodies and activities are being policed at both the most intimate and the most public levels of their lives. Diet culture and fat phobia constitute a violent assault on fat women, and the experiences of these characters offer a safe space where feminist scholars could explore the dynamics that function to hurt, minimise and isolate fat women beyond the texts.
Dieting attempts have become popular worldwide. Dieting, however, seems to have both positive and negative health-related consequences. So far, only a few studies have focused on the determinants of dieting in detail. This study explores the association between self-report dieting attempts and intentional weight loss (IWL) during the previous year and several demographic, lifestyle, health, and psychological factors in a cross-sectional study design using data from the representative Finnish Health 2000 Survey. The sample comprised 2147 men and 2378 women, aged 30–69. Information for potential determinants was assembled via health examinations, interviews, and questionnaires. Approximately 24% of the men and 39% of the women reported dieting attempts and 10% of the men and 15% of the women reported IWL. Dieting attempts were associated with younger age, education, BMI, formerly smoking, more favourable values in lifestyle variables, and unfavorable values in serum HDL and triglycerides, a worse sense of coherence, concerns about one’s appearance, and concerns about one’s health. Among men, diabetics and those sleeping ≤6 h a night more frequently reported dieting attempts and those with osteoarthritis reported IWL. Moreover, the gradient between BMI and dieting attempts was significantly stronger in men than in women. Men seem to attempt dieting when they have actual health-related reasons, while such reasons are not so strongly associated with dieting in women. These findings can be used for determining subpopulations with obesity and real weight-loss needs and, alternatively, subpopulations with normal weight unnecessarily attempting dieting.
Sizeism permeates and shapes how scientific and professional communities—including therapists—perceive, understand, and behave toward anyone considered fat. In this article, we use scientific evidence to argue for the recognition and establishment of fat acceptance to subvert sizeism. We first critically review the Weight Normative Approach, which dominates scientific discourse on weight, despite being based on sizeist assumptions that are discredited by data. We then articulate the tenets of the Weight Inclusive Approach, which honors size diversity and the promotion of wellness within a social justice framework. We end with strategies for therapists to align their practice with the Weight Inclusive Approach.
Background:
In an era when obesity prevalence is high throughout much of the world, there is a correspondingly pervasive and strong culture of weight stigma. For example, representative studies show that some forms of weight discrimination are more prevalent even than discrimination based on race or ethnicity.
Discussion:
In this Opinion article, we review compelling evidence that weight stigma is harmful to health, over and above objective body mass index. Weight stigma is prospectively related to heightened mortality and other chronic diseases and conditions. Most ironically, it actually begets heightened risk of obesity through multiple obesogenic pathways. Weight stigma is particularly prevalent and detrimental in healthcare settings, with documented high levels of 'anti-fat' bias in healthcare providers, patients with obesity receiving poorer care and having worse outcomes, and medical students with obesity reporting high levels of alcohol and substance use to cope with internalized weight stigma. In terms of solutions, the most effective and ethical approaches should be aimed at changing the behaviors and attitudes of those who stigmatize, rather than towards the targets of weight stigma. Medical training must address weight bias, training healthcare professionals about how it is perpetuated and on its potentially harmful effects on their patients.
Conclusion:
Weight stigma is likely to drive weight gain and poor health and thus should be eradicated. This effort can begin by training compassionate and knowledgeable healthcare providers who will deliver better care and ultimately lessen the negative effects of weight stigma.
Until recently, thematic analysis (TA) was a widely used yet poorly defined method of qualitative data analysis. The few texts (Boyatzis, 1998; Patton, 2002), chapters (Hayes, 1997) or articles (Aronson, 1994; Attride-Stirling, 2001; Fereday & Muir-Cochrane, 2006; Tuckett, 2005) often came from outside psychology, and were never widely taken-up within the discipline. Instead, qualitative researchers tended to either use the method without any guiding reference, or claim some mix of other approaches (e.g., grounded theory and discourse analysis) to rationalise what essentially was TA. Our 2006 paper (Braun & Clarke, 2006) developed TA (in relation to psychology) in a ‘systematic’ and ‘sophisticated’ way (Howitt & Cramer, 2008, p. 341). TA is rapidly becoming widely recognised as a unique and valuable method in its own right, alongside other more established qualitative approaches like grounded theory, narrative analysis, or discourse analysis.
TA is an accessible, flexible, and increasingly popular method of qualitative data analysis. Learning to do it provides the qualitative researcher with a foundation in the basic skills needed to engage with other approaches to qualitative data analysis. In this chapter, we first outline the basics of what TA is and explain why it is so useful. The main part of the chapter then demonstrates how to do thematic analysis, using a worked example with data from one of our own research projects – an interview-based study of lesbian, gay, bisexual and trans (LGBT) students’ experiences of university life. We conclude by discussing how to do thematic analysis well and how to avoid doing it poorly.
USING AN ETHICAL LENS, THIS REVIEW EVALUATES TWO METHODS OF WORKING WITHIN PATIENT CARE AND PUBLIC HEALTH: the weight-normative approach (emphasis on weight and weight loss when defining health and well-being) and the weight-inclusive approach (emphasis on viewing health and well-being as multifaceted while directing efforts toward improving health access and reducing weight stigma). Data reveal that the weight-normative approach is not effective for most people because of high rates of weight regain and cycling from weight loss interventions, which are linked to adverse health and well-being. Its predominant focus on weight may also foster stigma in health care and society, and data show that weight stigma is also linked to adverse health and well-being. In contrast, data support a weight-inclusive approach, which is included in models such as Health at Every Size for improving physical (e.g., blood pressure), behavioral (e.g., binge eating), and psychological (e.g., depression) indices, as well as acceptability of public health messages. Therefore, the weight-inclusive approach upholds nonmaleficience and beneficience, whereas the weight-normative approach does not. We offer a theoretical framework that organizes the research included in this review and discuss how it can guide research efforts and help health professionals intervene with their patients and community.
Thematic analysis is a poorly demarcated, rarely acknowledged, yet widely used qualitative analytic method within psychology. In this paper, we argue that it offers an accessible and theoretically flexible approach to analysing qualitative data. We outline what thematic analysis is, locating it in relation to other qualitative analytic methods that search for themes or patterns, and in relation to different epistemological and ontological positions. We then provide clear guidelines to those wanting to start thematic analysis, or conduct it in a more deliberate and rigorous way, and consider potential pitfalls in conducting thematic analysis. Finally, we outline the disadvantages and advantages of thematic analysis. We conclude by advocating thematic analysis as a useful and flexible method for qualitative research in and beyond psychology.
We argue that critiques of political process theory are beginning to coalesce into a new approach to social movements—a “multi-institutional politics” approach. While the political process model assumes that domination is organized by and around one source of power, the alternative perspective views domination as organized around multiple sources of power, each of which is simultaneously material and symbolic. We examine the conceptions of social movements, politics, actors, goals, and strategies supported by each model, demonstrating that the view of society and power underlying the political process model is too narrow to encompass the diversity of contemporary change efforts. Through empirical examples, we demonstrate that the alternative approach provides powerful analytical tools for the analysis of a wide variety of contemporary change efforts.
While the relationships between media and eating disorders and disordered eating patterns incollege-aged women have been extensively studied (e.g., Bissel, 2004; Grabe & Hyde 2009;Harper & Tiggeman, 2008; Yamamiya, Cash, Melnyk, Posavac, & Posavac, 2005), fewerstudies have been conducted with female athletes. More specifically, limited studies havefocused on the relationship between social media and eating behaviors of athletesparticipating in aesthetic sporting events, even though the highest rates of disordered eatingpatterns occur in sports where female athletes are scored on judges’ opinions (Hausenblas &Carron, 1999; Smolak, Murnen, & Ruble, 2000; Sundgot-Borgen, 1994), and where leanness,thinness, and aesthetic skills and aspects are emphasized (Byrne & McLean, 2002; DiBartolo& Shaffer, 2002). Thus, the current study sought to understand the links among collegegymnasts’ perceptions of body image, disordered eating behaviors, and perceptions ofathletes’ body images presented on social media. Furthermore, the study also explored howcriticism presented on social media relates to disordered eating symptomatology. The studywas conducted via an online survey system by 72 18-25-year-old females who were currentlycompeting or recently competed in club or collegiate gymnastics. Results found significantcorrelations between the severity of critical comments about physical appearance, emotionalreaction to criticism about physical appearance, and disordered eating behavior in instanceswhere the comments were not made on social media, but no correlation was found betweenseverity, emotional reaction, and disordered eating behaviors for comments made on socialmedia.
We trace our maternal line’s journey across four generations as they weave into and back out of (white) American diet culture, out of and back into observant Judaism. Using our memories, against the backdrop of larger social-historical forces, we put forth a method of “re-membering” ourselves: our bodies and our wholeness. The first Minna in our story, Minna Yorkowitz, arrived as an immigrant to New York in 1905. She was a large woman and an observant Jew. Her daughter Ida rejected everything having to do with Judaism and saw thinness as a way of fitting in. Ida’s daughter, Margaret, sought her own (re)connections with Judaism while struggling well into adulthood with restrictive eating and internalized fatphobia. Minna Bromberg, Margaret’s daughter, deepened her connection with Judaism, connected with the fat liberation movement and, as a rabbi, seeks to deploy Jewish text and tradition in liberatory ways. Our “Fat Torah” approach looks at how diet culture is idolatrous and guilty of undermining the inherent worth of every human being. We offer a “re-braiding” that allows us to bring together each of our lives into a new wholeness.
Informed by Andrew Dickson’s paper “Biomassochism: Lacan and the Ethics of Weight Cycling,” this paper explores the paradoxes and nuances of lack and power in women’s strength sports in the United States. Utilizing historical analyses of anti-blackness and sexism in the social milieu alongside the author’s personal experience as a strength athlete, this paper explores the jouissance of a strength athlete’s experience of pain alongside the pleasure of competition, and purposive “lack” as represented by encounters with failure embedded in athletic performance. Lack and failure are also taken up within a framework of diet and exercise culture. The paper also explores how purposive encounters with lack and failure function as an aspect of indigenous narrative (Tummalla-Narra, 2015), and can be utilized as tools to reclaim a sense of selfhood and agency. Additionally, the paper takes up aspects of anti-blackness and patriarchy embedded in “wellness” culture, how a settler-colonial patriarchal environment functions to de-link subjectivity from bodily autonomy and experience, and the ways in which strength sports may enforce, or reclaim, these delinked identities.
In this collection of interviews with Jewish fat liberationists, Merissa Nathan Gerson traces the centrality of Jewish women to the beginnings of the fat liberation movement in the 1970s and 1980s. She links the history of Jewish women’s involvement in fat liberation to radical black queer fat acceptance in the 1960s. Incorporating the theorizing of Sabrina Strings, Merissa underscores how fatphobia began during the Enlightenment as a way to associate fatness with savagery and racial inferiority. This led to the racist creation of the BMI and the continuation of white supremacy within WASP-centered beauty norms. Jewish women especially have internalized these white American esthetic ideals, leading to what Rabbi Minna Bromberg terms “diet culture as idolatry.” Many of the interviewees, who come from a diverse range of religious practices and professions, describe the ways their Jewish mothers emphasized dieting as a way to control “Jewish wildness.” They challenge the idea that fat is unhealthy and maintain that Jewish communities must confront their fatphobia. Three key Jewish ideas are interwoven throughout: bezelim elohim, tikkun halev, and tikkun olam [made in God’s image, healing the self or the heart, and healing the world]. These three tenets articulate how Jewish traditions already include the philosophies needed to go beyond fat acceptance to advocate for fat liberation.
Fully qualitative surveys, which prioritise qualitative research values, and harness the rich potential of qualitative data, have much to offer qualitative researchers, especially given online delivery options. Yet the method remains underutilised, and there is little in the way of methodological discussion of qualitative surveys. Underutilisation and limited methodological discussion perhaps reflect the dominance of interviewing in qualitative research, and (misplaced) assumptions about qualitative survey data lacking depth. By discussing our experiences of developing online surveys as a tool for qualitative research, we seek to challenge preconceptions about qualitative surveys, and to demonstrate that qualitative surveys are an exciting, flexible method with numerous applications, and advantages for researchers and participants alike. We offer an overview and practical design information, illustrated with examples from some of our studies.
Objectification theory (Fredrickson & Roberts, 1997) provides a framework for understanding how cultural pressure on women’s appearance (i.e., sexual objectification) impacts their psychological and physical well-being. Although objectification theory proposes that objectification processes commence with the onset of puberty, much of the existing research on self-objectification has been conducted with adult women. Thus, less is known about how self-objectification operates with younger girls and adolescent girls. In this paper, we provide a comprehensive review of self-objectification research on girls under the age of 18 including the prevalence, predictors, and outcomes of self-objectification as well as protective factors (n = 66 studies). In addition, we discuss how development is relevant to objectification theory and self-objectification. Finally, we call for a program of research that addresses methodological and conceptual concerns in existing research, fills gaps in the research literature, and pays further attention to developmental processes in self-objectification. An especially notable pattern we identified is that self-objectification is strongly related to age, such that older girls experience higher levels of self-objectification compared to younger girls. The aim of this paper is to provoke deeper considerations of development and the inclusion of girls in future research on self-objectification.
The aim of this systematic review is to answer the question: Is substantial, stable, and long-term weight loss a viable goal for adults with obesity? To answer this question, we conducted a broad systematic search of non-surgical and non-pharmacological obesity treatment studies with the following strict criteria: (a) minimum 3-year follow-up, (b) 5% body mass lost, (c) no continued interventions in the follow-up-period, (d) prospective design, and (e) less than 30% attrition from the start of the follow-up period. While the search revealed a very large number of published articles, only eight studies met the inclusion criteria. Several of the nonincluded studies report a majority of participants achieving satisfactory weight loss and little regain, especially among studies with continued interventions during the follow-up period. In contrast, the eight high-quality studies included in this study demonstrate a trend of weight regain towards pretreatment baseline. This review concludes that the majority of high-quality follow-up treatment studies of individuals with obesity are not successful in maintaining weight loss over time. The results suggest that excess weight can be lost but is likely regained over time, for the majority of participants.
Anti-fat bias is a persistent and widespread barrier to body liberation that psychotherapists are ethically bound to do something about. Though academics and clinicians have written about the implications of weight stigma in psychotherapy, the prevalence of anti-fat bias in our profession remains and often goes unexamined. Here we explore the nature of anti-fat bias and reasons to shift to a weight-inclusive stance. We offer examples of how anti-fat bias operates in the therapy room and the harm it causes. Anti-fat bias and body-based oppression as forms of microaggressions are explored, and we make the case for body liberation as a social justice issue. We conclude with recommendations for addressing anti-fat bias, including: developing a liberatory consciousness, the importance of moving from awareness to action, examining our relationship to diet culture, ways to avoid stigmatizing language, bringing a social justice lens into the room, and doing our own work so that we stop locating the problem in people’s bodies and provide truly bias-free psychotherapy.
The gender narrative of the 1960s frequently focuses on the reemergence of feminism, yet a growing diet culture provides an alternate entry point for investigating the era and its gendered foodways. The growth of both movements also provides a new perspective on the consumer landscape and ideals regarding female dieting behaviors. To that end, this article interrogates advertisements for the popular appetite suppressant Ayds, the first to use before-and-after photography and a first-person narrative to detail a woman's weight-loss journey. Using Erving Goffman's frame analysis theory to examine gender while applying a feminist-inspired lens to the text, a female identity emerges. Called the Modern American Dieter, she was a woman trapped between a traditional past and the promise of a new, feminist-inspired future. Both worlds were shaped by the era's marketers, who created a modern dieting narrative (using commodity scientism and female empowerment) that still exists today to sell weight loss.
Studies show that women with high BMI are less likely than thinner women to seek healthcare. We aimed to determine the mechanisms linking women's weight status to their healthcare avoidance. Women (N = 313) were surveyed from a U.S. health-panel database. We tested a theory-driven model containing multiple stigma and body-related constructs linking BMI to healthcare avoidance. The model had a good fit to the data. Higher BMI was related to greater experienced and internalized weight stigma, which were linked to greater body-related shame. Internalized weight stigma was also related to greater body-related guilt, which was associated with higher body-related shame. Body-related shame was associated with healthcare stress which ultimately contributed to healthcare avoidance. We discuss recommendations for a Weight Inclusive Approach to healthcare and the importance of enhancing education for health professionals in weight bias in order to increase appropriate use of preventive healthcare in higher weight women.
A flurry of recent articles in the medical and popular press have decried black women’s “alarmingly high” rates of obesity. The number of high-profile publications lamenting the “epidemic” among black women has grown, even as mounting evidence indicates that obesity (defined as a body mass index ≥ 30) does not necessarily lead to poor health outcomes. Indeed, given its functional limitations in explaining or predicting health status, a number of medical researchers are now issuing calls to revise the standard definition of obesity. In this article, I examine the curious nature of the discourse decrying the obesity epidemic among black women. I argue that rather than being a novel concern about black women’s health or public health, the medical and popular discourse about obesity and black women is largely a reproduction of the trope of the diseased black woman that has been used throughout American history. This trope reifies the purported sensualism of black women. Moreover, the newest incarnation of this discursive device is distinct in that it renders black women as triply signified “social dead weight.”.
Objectives:
The overall aim of the study was to investigate the applicability of Objectification Theory to the mental health of early adolescent girls, in particular, their dieting behaviors and depressive symptoms. Both predictors and consequences of self-objectification were examined.
Methods:
A sample of 204 girls with a mean age of 11.6 years completed questionnaire measures of media consumption, time spent on sports and hobbies, appearance conversations, self-objectification, body shame, dieting, and depressive symptoms.
Results:
Structural equation modeling showed that magazine and Internet exposure and appearance conversations with friends predicted self-objectification. Self-objectification itself predicted body shame, which in turn predicted both dieting and depressive symptoms, in accord with the pathways postulated by Objectification Theory.
Conclusions:
The results confirm that, as is the case with adult women, self-objectification plays a significant role in the mental health of early adolescent girls.
Obesity is high on the agenda of governments and health and welfare agencies worldwide. The placement of body weight at the centre of discourse about health is referred to as the weight-centred health paradigm (WCHP). Critical analysis of the WCHP has increased in recent years, resulting in arguments for a paradigm shift. Critique of the WCHP encompasses ideological, empirical and technical issues. The consequences of the WCHP have been identified as an adipophobicogenic environment (an environment that creates fat hatred and weight stigma), and diminished health, wellbeing and quality of life for people with weight concerns. Many critics argue that it is time for a change of paradigm. The Health at Every Size® (HAES)® approach offers a more salutogenic, compassionate, humane and evidence-based approach to weight concerns. HAES is a strengths-based, ethical approach to enhancing the holistic health and wellbeing of all people. It does not advocate that people are automatically healthy at every size, but that people at every size can be supported to adopt practices that will enhance their health and wellbeing, irrespective of whether these practices result in changes in body weight. The HAES approach aims to empower people to do what they can to improve their health, including developing their resilience and capacity to cope with the trauma of living in a weight centred and adipophobic society. Ultimately, the HAES approach aims to create hope for people to make peace with their bodies.
Using feminist theory about the social construction of the female body, a scale was developed and validated to measure objectified body consciousness (OBC) in young women (N= 502) and middle-aged women (N= 151). Scales used were (a) surveillance (viewing the body as an outside observer), (b) body shame (feeling shame when the body does not conform), and (c) appearance control beliefs. The three scales were demonstrated to be distinct dimensions with acceptable reliabilities. Surveillance and body shame correlated negatively with body esteem. Control beliefs correlated positively with body esteem in young women and were related to frequency of restricted eating in all samples. All three scales were positively related to disordered eating. The relationship of OBC to women's body experience is discussed.
This article considers some implications of the new health consciousness and movements--holistic health and self-care--for the definition of and solution to problems related to "health." Healthism represents a particular way of viewing the health problem, and is characteristic of the new health consciousness and movements. It can best be understood as a form of medicalization, meaning that it still retains key medical notions. Like medicine, healthism situates the problem of health and disease at the level of the individual. Solutions are formulated at that level as well. To the extent that healthism shapes popular beliefs, we will continue to have a non-political, and therefore, ultimately ineffective conception and strategy of health promotion. Further, by elevating health to a super value, a metaphor for all that is good in life, healthism reinforces the privatization of the struggle for generalized well-being.
In this article, the author takes up the debate about the usefulness of the concept of validity in qualitative research and acknowledges the critical role of the researcher as an "instrument" in the research process. Qualitative research, and the process of analysis in particular, involves continuous reflexivity and self-scrutiny. Balancing the need for creativity and rigor, the qualitative researcher can experience uncertainty, particularly in relation to small numbers. The author describes steps that she and a colleague took to ensure the validity and accuracy of the findings in a qualitative study of female sex workers. She discusses specific challenges in relation to the validity of their interpretation and describes two unexpected and serendipitous validity checks that served as affirmation.
Objectification theory
- Fredrickson
Why fat activist Dani Adriana says “fuck you” to diet culture
- Klower
Surviving and thriving while fat
- Rashatwar
Fat as a feminist issue: A history
- Simic