Celebrating National Nutrition Month highlights the fun and enjoyment that nourishing the body offers. Each March, countless people are encouraged to ‘eat right’ to be healthy. While I empathize with the intention, the pandemic has made it hard not to see the health inequity that grips our country. Below that issue lies the existing harm caused by food judgment, body shame, and weight stigma.
Many professionals are unaware that disordered eating is just as ‘big’ of an issue as diabetes! 30 million people suffer from an eating disorder such as anorexia nervosa, bulimia nervosa, or binge eating disorder. While this number is likely underreported, it is similar to the 2018 Centers for Disease Control and Prevention (CDC) findings that 34.2 million Americans have diabetes.
Like diabetes, much of the disordered eating goes unrecognized and untreated, and only one out of ten people with eating disorders will receive treatment (Mirror-Mirror.org). Yet, the overlap of these two conditions is shockingly high and may affect up to 40% of patients with type 2 diabetes mellitus (García-Mayor 2017). This is because eating disorders affect people of all sizes, and they remain, and in large part, are invisible.
Weight stigma or weight-based discrimination happens when society devalues or degrades people perceived to carry excess weight. Tomiyama 2014 research shows this leads to prejudice, negative stereotyping, and discrimination toward those people. It is a significant factor because, in medical settings, it is linked to the avoidance of medical care (Phelan et al. 2015). Many professionals are unaware that experiencing weight stigma can lead to a host of behaviors that can negatively impact glucose control, including increased eating and decreased self-regulation, higher cortisol levels, avoidance of exercise, and a greater likelihood of experiencing anxiety disorders (Schvey 2011) (Major et al. 2014).
In 2021 shouldn’t our professional organizations look beyond surface-level nutrition issues and take to heart that people who experience weight stigma have also been found to have a 60% increased risk of dying, independent of BMI (Tomiyama 2018). The cause of this startling statistic is not due to a single variable but a complex interaction with misdiagnosis and misattribution of symptoms based on weight and a higher likelihood of being prescribed weight management instead of necessary interventions for actual health conditions. What is worse is weight stigma creates a lower likelihood of the patient following provider recommendations and can foster the desire to delay care or minimize symptoms which result in worse health outcomes and more advanced disease states.
Embracing trauma-informed care is more than encouraging clients to “Personalize Your Plate“. It is asking our government, funders, and professional associations to stop telling the individual to change and start creating training to show professionals how to come alongside our clients who are suffering, incorporating nonjudgmental counseling techniques outlined in motivational interviewing, trauma-informed care, or mindful eating.
Professionals need top-down support from our associations to practice until we are able to see our bias, privilege and are proficient in providing nonjudgmental nutrition care. I invite the Academy of Nutrition and Dietetics, the American Diabetes Association, and the Association of Diabetes Care and Education Specialists to look at these troubling statics and consider how a systematic change to a weight inclusive approach would make it possible for everyone to celebrate National Nutrition month!
Megrette Fletcher is a dietitian, diabetes care and education specialist, author, co-founder of The Center for Mindful Eating, and the current owner of the WN4DCSymposium.com