Judith Matz, MSW, LCSW Ellen Frankel, MSW, LCSW
Over 116 million Americans, more than half of the adult population, continue to diet, despite the fact that there is not a single study to support that diets result in long-term weight loss (Tsai & Wadden, 2005). The phrase “diets don’t work” is familiar to both health professionals and the public at large. In fact, not only do diets not work, but they actually exacerbate the very problems they purport to solve, including risk for eating disorders (Patton, et al, 1990), higher rates of depression (Ross, 1994; Kennardy, Brown, & Vogt, 2001), higher risk of cardiovascular disease and diabetes as the result of weight cycling (Gaesser, 2002) and, perhaps most insidious of all, higher than pre-diet weights for the majority of those who use them (Gaesser, 2002; Stice, Hayward, Taylor & Killen, 1999).
Despite these consequences, the weight loss industry continues to prosper as people cling to any hope that there is a plan or product that will make them thinner. Furthermore, health professionals frequently support dieting behavior for their clients/patients, either implicitly or explicitly, and may engage in dieting behaviors themselves.
What is the explanation for this blatant disregard of both personal experience and factual information? Disavowal, a psychological defense process in which a person both knows something and “chooses” not to know at the same time, operates at a both individual and cultural level when it comes to dieting. Fueled by shame, people cannot afford to let go of the fantasy of thinness or accept the reality that people naturally come in different shapes and sizes. Shame originates as people feel, and are made to feel, that their bodies are defective. People are told that the way to become acceptable is through dieting, resulting in further shame when the diet fails. The failure rate of diets stands at 95–98%, a rate that would be unacceptable in any other area of medical treatment.
The Diet Survivor’s Paradigm
We developed the diet survivor’s paradigm to give validation to the experiences of the great majority of dieters. We define a diet survivor as anyone who has been on more than one diet, lost and regained the weight, and is in the process of understanding that diets don’t work. The use of the term “survivor” is familiar in the field of sexual abuse. It was an important classification because it gave validation and strength to a group of people who shared common characteristics, but suffered in shame and silence. Furthermore, victims of abuse could now come together under a positive rubric that said the abuse was not their fault and that there was a process to undertake that would lead to an improved quality of life; the goal of these endeavors was to empower individuals. Likewise, naming the act of ending diets as “survival” gives credence to both the damage caused by diets and the empowerment that results when people change from a diet mentality to a healthy relationship with food, which is based on attunement to internal cues for hunger and satiation. Diet survivors now become an identifiable group of people who share common characteristics and strengths. Moving beyond the knowledge that diets don’t work, survivors can move toward a positive definition of themselves in relation to food, acceptance, and self-care. In our book, The Diet Survivor’s Handbook: 60 Lessons in Eating, Acceptance and Self-Care, we define three important stages in the process of becoming a diet survivor.
It’s Not The Dieter’s Fault
First, dieters must understand that the failure is not their fault. Dieters typically invest large amounts of time, energy, and money into weight loss plans. They experience positive feelings and receive compliments from others when pounds are shed. Given these benefits, it is important for the dieter to become curious about why he or she, like virtually all dieters, regains the weight. The answer is that the flaw is in the diet itself.
Despite the unique personalities and stories of each person, dieters share similar characteristics and experiences. Diets always begin with a negative thought or feeling about oneself. “I’m unhealthy,” “I’m out of control with food,” “I’m too fat,” or “my stomach sticks out” are typical of the comments that motivate people to diet. With resolve and hopefulness, the person starts a new diet and is likely to lose some weight, leading to a sense of being in control. Eventually, in a day, a week, a month or year, the dieter breaks out of the restraints of the plan. Perhaps the dessert at a party looks too good to pass up, or a stressful situation at work triggers overeating. When this occurs, the dieter will feel upset about losing control. At the same time, he or she is likely to overeat in response to past deprivation. The dieter’s mindset is, “I’ve already broken the rules. I’ll be starting a new diet at some point in the future, so I might as well eat whatever I want now” (Herman & Polivy, 1984). The lost weight returns. Instead of receiving compliments, there is now silence from friends and family. This sequence of events causes the dieter to have negative thoughts about him or herself, leading to the next diet and perpetuating the cycle of dieting and overeating. People who regain lost weight typically feel some or all of the following:
• I am weak: a stronger person could have kept the weight off.
• I am bad: a good person would have stayed on the diet and become thin.
• I am lazy: I cannot be counted on to succeed.
• I feel helpless: I don’t know what to do to lose weight and make my body acceptable.
• I feel shame: I’m embarrassed that I failed and I’m disgusted with my appearance.
It is important for dieters to understand that the reason these feelings are predictable is because dieting creates a scenario with predictable results. When a pattern occurs in such a predictable way, it can no longer be considered an individual failure. Rather, the fact that certain feelings, behaviors, and consequences occur frequently and consistently for people in a particular situation means that the problem lies outside of the individual, regardless of his or her own set of unique circumstances.
Dieters of all sizes feel their body is unacceptable because it fails to meet the societal view of perfection, which ultimately doesn’t exist. We live in a shame-based culture that says if a person’s body differs from the coveted thin physique, something is intrinsically wrong and in need of fixing. The worth of a person has become inaccurately defined and simplified as thin equals a good, moral person and fat equals a bad, shameful person. The words used by dieters in everyday speech exemplify the extent to which shame has been incorporated into the core of the dieter’s identity. Statements such as, “I was bad today,” referring to what one ate, or “I’ve let myself go,” reflect the process of accepting the shame-based culture into the dieter’s psyche. As diet survivors name these cultural messages as the form of oppression they are, they can begin the process of healing.
Identifying the Culprit
As dieters shift the blame of diet failure away from themselves, they must identify the culprit in perpetuating the myth that diets lead to permanent weight loss. Dieting has become one of the great American pastimes. People read about the latest diet craze, enter weight loss contests, talk about their diet struggles, celebrate the loss of pounds, and commiserate over their eventual return. Underneath the weight loss frenzy is the conviction that with any diet, it is ultimately a matter of willpower, strength, and determination that make people successful in their quest to be thin.
It is no coincidence that these are the traits so highly valued in the dieting culture as they mirror the highly valued qualities embedded in the society at large. They are the traits that are told in the tales of those who achieved the American Dream. The notion of pulling yourself up by your bootstraps, and the idea that with enough hard work, perseverance, determination, and commitment one can achieve success, are the stories upon which this nation was founded. Those who achieved such positions, the political and economic elite, have had great influence on the shaping of beauty ideals at various points in time as a reflection of who has achieved “success” and who has not.
Thin and fat have become code words full of meaning, and the national pursuit of slenderness has reached a point where the character of a person is deduced from the size of his or her body. If the origin of the American Dream is about attaining a certain level of economic success regardless of one’s initial circumstances, attaining the American Dream in the physical realm means getting and staying thin regardless of one’s initial circumstances, that is, body type. Just as the American Dream promises that in this land of equality and opportunity, with enough self-reliance, hard work, and determination everyone can achieve economic success, so too have people been taught that this holds true in the realm of dieting.
Over the years it became apparent that while the American Dream was held out as the reward for those who exemplified those highly regarded qualities, not everyone who was determined, worked hard, and persevered attained economic success. The fact that inequities existed within the system, which impacted on one’s ability to succeed, ultimately led to the involvement of the judicial and legislative branches of government in an effort to address an uneven playing field.
Likewise, the dieter is on an uneven playing field. Some people are naturally thinner while others are naturally larger. Some people are short while others are tall. Body size is less malleable than the current beliefs about dieting would suggest (Stunkard, Harris, Pedersen & McCleam, 1990). The idea that dieting is the great equalizer of body types, and that it is possible for anyone committed to dieting to permanently lose weight, has hurt countless numbers of people. Every person has a set point or weight range that the body seeks to maintain. Taking in less food leads to a lower metabolism to conserve energy and taking in more food speeds up metabolism. In this way the body is able to maintain its set point range and allow individuals to settle at the weight that is natural and healthy for them.
When a person embarks on a diet, regardless of what plan, the body prepares for famine. When the dieter takes in more food, which is almost always inevitable, the body learns to store fat more efficiently in preparation for the next famine/diet. This is why dieting so often leads to higher than pre-diet weights. Far from being the great equalizer, dieting wreaks havoc on the body and encourages physiological responses that move the dieter further away from the intended goal.
Given that the idea that every body can attain a certain level of thinness is preposterous, who benefits from the dieter’s belief that it is his or her own lack of willpower that accounts for the diet failure? Advertisers and weight loss programs, part of the 30 to 50 billion dollar per year industry, repeatedly make claims that their weight loss plan will make a person thinner, more attractive, happier, and successful. Consumers are left feeling that they, too, can achieve success and rarely notice the disclaimer, written in very small print, that results from the product/plan are not typical.
From 1992 to 1993, the Federal Trade Commission charged seventeen weight loss companies, including the five biggest in the United States, with making false and deceptive claims about the safety and efficacy of their programs. They discovered that less than one percent of people were able to maintain weight loss for five years despite the companies’ insistence that their programs were effective (Consumer Reports, 1993). Furthermore, leading obesity researchers often have an economic stake in promoting commercial weight loss programs as they serve as consultants or researchers for—or present at conferences sponsored by—the weight loss companies (Fraser, 1997; Berg, 2000).
In this second step of becoming a diet survivor, people must understand that they are not to blame, and that there are strong economic rewards for those in the diet and advertising industries to promote weight loss through dieting. The weight loss industry, taking advantage of the values embedded in the American dream, benefit when people feel insecure about their bodies and then believe that a weight loss product is the solution. The idea that people can accomplish anything with the right attitude and values keeps people trying over and over again, but this reasoning fails to address the impact of genetics, physiology, and evolution in matters of body size and weight regulation. Of course, there are choices that each individual can making regarding food, activity, and lifestyle, but even if everybody ate the exact same foods and engaged in the same amount of daily activity, there would still be a wide variation in body sizes.
Rather, diet survivors must realize that they have survived in a land abundant with diet and weight loss myths, fertile with products and gimmicks. Diet survivors must raise their voices and say no to the manipulation and false promises. They must assert their right to life, liberty and the pursuit of happiness at any body size.
Reclaiming One’s Life
The final step in becoming a diet survivor is to reclaim one’s life. Knowledge and information about the inherent failure of diets translates into power. The process of living as a diet survivor includes establishing a normal relationship with food, reaching a place of acceptance with oneself and one’s body, and taking very good care of one’s needs. The process of accomplishing these goals are well described in the non-diet, size acceptance, and Health At Every Size literature, and provide the basis for a rewarding journey toward wellness.
As people weigh the evidence that proves the dieting is a faulty process, based on faulty assumptions and driven by economic incentive, they will come to understand that they have been falsely accused of lacking willpower and acting weak. On the contrary, they are strong, and must now see themselves as diet survivors. Yet the relief of the knowledge that the individual is not at fault, and that the diet itself is to blame, can quickly turn to sadness and grief because of the significant loss experienced by giving up the belief that dieting will permanently change one’s body. With that loss is the letting go of the fantasy that thinness leads to happiness, success and love.
There are five stages in the process of loss and grief. As diet survivors contemplate the meaning of ending diets, they can consider where they are in the process.
Denial:
People may find themselves questioning whether they must truly give up on the idea that diets can make them permanently thinner. After all, research shows that diets fail in the long term about 95–98% of the time. That still leaves a tiny percentage of people who have lost weight without regaining it back. The diet survivor might imagine he or she can become one of those people, even though experience says otherwise. Dieting is seductive, and a person may be in denial about the inherent failure of diets. He or she may need to engage in another cycle of dieting before being convinced that this is true for him or her.
Anger:
Diet survivors may lament “Why me?” They may turn their anger against themselves by berating their body, or they may direct their anger at others. It may seem unfair that some people are naturally thin no matter what they do, while they have tried so hard to achieve that body size. As diet survivors come to understand the physiology of their bodies, they may also become angry when others continue to judge them based on size.
Bargaining:
Even though the concepts related to diet failure make sense, there is a wish to diet one more time to lose weight before incorporating principles of attuned eating and acceptance. The attitude is “Let me just lose weight first, and then I’ll quit dieting.”
Depression:
Diet survivors are being asked to live their lives without the goal of weight loss when, up until now, their lives have been focused and organized around this premise. The sadness of shifting beliefs about the merits of dieting and the requisite of thinness is a difficult challenge. Diet survivors may feel that they are being asked to give up on themselves when, in fact, the opposite is true. Diet survivors have the opportunity to live an authentic life based on principles that contribute to physiological, psychological, and spiritual well-being.
Acceptance:
This is the point where diet survivors accept the inherent failure of diets and no longer choose to diet in an effort to become thinner. At this stage, diet survivors understand that dieting wreaks havoc on their ability to find their natural weight. They see the cost of dieting in both physical and emotional terms, and they are no longer willing to pay the price. They are committed to taking care of themselves in the best way they can, and allowing their weight to settle in its natural range as a function of attuned eating and engaging in physical activity that suits both their body and their lifestyle.
These stages of loss are not always distinct, and diet survivors may find themselves experiencing two stages simultaneously or moving back and forth between the various stages.
The diets survivor’s paradigm offers a framework to help people make sense of their experiences with diet failure and provides the opportunity to identify with a group of people who show courage and strength in their decision to let go of the destructive diet cycle. Rather than continuing the shame and isolation so prevalent among dieters, this paradigm gives individuals and health professionals a positive way to organize the dynamics of diet failure, allowing people to move toward a new definition of health that is no longer based on weight. Individuals can focus their efforts on the process of moving from a sense of shame to a newfound experience of empowerment.
Portions of this article were excerpted from our book, The Diet Survivor’s Handbook: 60 Lessons in Eating, Acceptance and Self-Care (Sourcebooks, February 2006).
Judith Matz, MSW, LCSW, and Ellen Frankel, MSW, LCSW are sisters and clinical social workers specializing in eating problems and weight issues. They are the authors of Beyond a Shadow of a Diet: The Therapist’s Guide to Treating Compulsive Eating (2004) and The Diet Survivor’s Handbook: 60 Lessons in Eating, Acceptance and Self-Care (2006).
References
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This article is from the Health at Every Size Journal and can be cited as Judith Matz, MSW, LCSW and Ellen Frankel, MSW, LCSW, “The Diet Survivor’s Paradigm: From Shame to Empowerment” from Health At Every Size 20:1 (Spring 2006).
