In a world saturated with diet culture and conflicting messages about food, the "anti-diet" approach has emerged as a refreshing and empowering perspective. This approach, often championed by registered dietitians (RDs), challenges conventional wisdom by prioritizing well-being, intuitive eating, and body positivity over restrictive diets and weight loss as the primary goal. It encourages individuals to develop a positive relationship with food and their bodies, moving away from the harmful cycle of dieting and weight stigma.
Understanding the Anti-Diet Framework
The anti-diet framework isn't about rejecting evidence-based nutrition principles; rather, it rejects the diet culture that has developed around them. It offers an alternative to the long-standing discourse that favors rigid rules and restrictions, which have not served many patients well. It's crucial to understand that the terms and approaches cited in the article-Anti Diet, Intuitive Eating, Health at Every Size, and food freedom-are concepts and counseling frameworks. These frameworks address the pervasive shame and stigma around food and body image.
What is Diet Culture?
Diet culture is a pervasive system of beliefs that equates thinness with health and moral virtue, promotes weight loss as a means of attaining higher status, and demonizes certain foods or food groups. This culture fosters an unhealthy obsession with body size and shape, leading to disordered eating patterns, negative body image, and mental health issues.
The Core Principles of the Anti-Diet Approach
The non-diet approach features include those similar to Health at Every Size® (HAES®), Intuitive Eating, and the Satter Eating Competence Model (1).
- Rejecting Diet Culture: The non-diet approach rejects the cultural pressure that weight loss is the key to health. Eating is seen as normal without labeling certain foods as “good”, “bad”, “healthy”, “or unhealthy”. Non-diet nutrition is encouraged, with a focus on enjoying a variety of foods.
- Embracing Body Positivity: This involves accepting and appreciating bodies of all sizes and shapes, recognizing that beauty and worth are not determined by physical appearance.
- Practicing Intuitive Eating: This involves listening to internal cues of hunger, fullness, and satisfaction to guide food choices, rather than relying on external rules or restrictions.
- Focusing on Overall Health: The non-diet approach recognizes that health is multifaceted and includes physical, mental, and emotional well-being. People also have the right to choose not to pursue optimal health without having a lowered feeling of self-worth. You can learn more about this ideology in the DSC Weight Stigma course created in partnership with Kyla Blackie, RD.
The Problem with Dieting
Dieting and weight loss diets can be harmful to both physical and mental health. Weight loss diets often involve restriction (of calories, certain foods, or food groups) and relying on external cues (ie. stopping eating once you’ve reached your calorie limit for the day, vs. stopping eating because you feel satiated) for making dietary choices. Additionally, diets usually don’t “work” to achieve the individual’s desired weight loss results in the long-term (4).
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Dieting, including restrictive diets and weight loss diets, can lead to:
- Nutrient deficiencies: Diets often eliminate entire food groups. This can result in deficiencies of vitamins, minerals, and other essential nutrients.
- Disordered eating: Diets can contribute to the development of disordered eating patterns, such as binge eating, purging, and food and body preoccupation. Relying on external cues and the rules and limitations of diets can trigger feelings of guilt, shame, and anxiety around food.
- Negative impact on mental health: Diets can have a negative impact on mental health, leading to increased stress and anxiety. This can have a negative impact on quality of life and overall well-being.
- Weight cycling: Diets can lead to lowered physical and mental health in the long-term due to weight cycling, where individuals repeatedly lose and regain weight.
The Allure and Harm of Celebrity Diets
As health professionals, we often see the effects of the latest celebrity diets on our clients’/patients’ health. These diets can be harmful and misleading and promote unhealthy restrictive behaviors. Celebrities and influencers often promote diets through social media, interviews, or endorsements. These diets typically promise quick weight loss or improved health & wellness and usually involve restrictive eating patterns or expensive supplements.
Celebrity diets can be nutritionally inadequate because they are often based on very restrictive eating patterns or eliminating entire food groups. This can lead to nutrient deficiencies. They can be misleading, promoting quick weight loss or other health benefits that are not backed by evidence. This can mislead the public and cause followers of the diet to have lowered feelings of self-worth when the diet doesn’t work as well for them as their favorite celeb. They can promote disordered eating: Many celebrity diets involve extreme calorie restriction (such as Gwyneth’s wellness routine) or demonization of certain foods which can promote disordered eating behaviors. They can perpetuate weight stigma: Celebrity diets often promote a narrow standard of beauty and body size, which can perpetuate weight stigma and discrimination. They can be expensive: Many celebrity diets involve expensive supplements or meal plans, which can be financially burdensome for individuals. Often, promoters of these diets don’t take into consideration the impact of socioeconomic factors on dietary choices and overall health.
Some dieting programs and influencers may also promote their diet through an anti-diet lens, claiming not to be a “diet” but a “lifestyle”. Still, these diets often promote dieting behaviors including:
- Relying on external sources, rather than internal cues, to decide what and how much to eat, move, and how to feel about one’s body
- Assigning moral value to foods (labeling foods as “good” or “bad”)
- Quality of self and health are associated with weight, “hard work”, or dietary choices
- Promoting the program with images of individuals in smaller bodies or muscular bodies but not those in larger bodies
The Role of Registered Dietitians (RDs)
Registered Dietitians (RDs) are trained to independently evaluate foods and make informed recommendations for their patients and the public. RDs who provide evidence-based care are unlikely to recommend extremes in either direction, such as a strict diet of kale and tuna or a Twix and Cheetos only eating pattern. They critically assess scientific literature, focusing on rigorous studies to inform their recommendations. The phrase “anti-diet dietitian” can be confusing, especially since the word “diet” is in the word “dietitian!” What anti-diet means is anti diet culture. Anti-diet dietitians don’t buy into the obsession with thinness, weight loss, or using food as a means to restrict. Anti-diet dietitians don’t believe there are “good” foods and “bad” foods, or “healthy” foods and “unhealthy” foods. We know that the reasons we choose certain foods can be complex and that there is more benefit to foods than just the nutrients they supply. We understand that our culture’s rampant anti-fatness is rooted in white supremacy and patriarchy and is another form of oppression. We know that weight stigma is everywhere, including healthcare, and has myriad negative consequences. We support our clients in finding ways to nourish themselves that feel connected, accessible, flexible, sustainable, and compassionate. Anti-diet dietitians don’t make assumptions about you based on your weight. And, we probably won’t even ask you what your weight is! (Note: Weight is monitored in certain stages of eating disorder recovery). So many of our clients have been on every diet out there and know through personal experience that diets do not work.
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The Anti-Diet RD's Toolkit
In these cases, skilled registered dietitians use principles of Intuitive Eating or Anti Diet frameworks to help patients create a neutral internal monologue and a more flexible approach to feeding themselves. Scientific literature and the combined experience of 70+ RDs on the Culina Health team support using education, empowerment, and patient buy-in for positive health benefits. Chavkin and his colleagues also failed to convey that these approaches can be used alongside education on balanced eating patterns and nutrition recommendations for preventing and managing chronic disease. This includes nutrition therapy for the conditions the authors purport to be so concerned about like diabetes, and heart disease. Nutrition guidelines from medical organizations like the American Diabetes Association, American Heart Association and the American College of Cardiology echo this idea, supporting eating patterns that limit, but do not necessarily exclude, the “nutrients of concern” we tend to find in highly processed foods. It is factually true that our patients can enjoy some of their favorite baked goods or packaged snacks while eating in a way that is associated with decreased risk of heart disease, kidney disease, diabetes, Alzheimer’s disease, and certain cancers. When patients are able to assess their food choices objectively, without a cloud of judgment and fear hanging over them, they often do a better job of striking the right balance. Using an anti-diet approach is in no way an endorsement of the food industry’s current practices. Registered dietitians are simply trying to help patients optimize their health in our current food environment.
RDs often achieve similar results by exploring the context and content of a patient’s “food noise” and providing tools to shift their internal monologue. We leverage concepts from intuitive eating and anti-diet frameworks as part of this work. Skilled registered dietitians use principles of Intuitive Eating or Anti Diet frameworks to help patients create a neutral internal monologue and a more flexible approach to feeding themselves.
Navigating the "Food Noise"
Did you know that you have a relationship with food? This idea might seem abstract. A concrete example is the “food noise” often discussed with GLP1 Receptor Agonists like semaglutide and tirzepatide (Ozempic, Weygovy, Mounjaro, and Zepbound). “Food noise” refers to the ongoing internal monologue many of us experience around food. It includes thoughts about whether to eat, when to eat, and what to eat. GLP1-RAs address this by reducing hunger cues and altering dopamine signaling in the brain, which registers and seeks rewarding experiences.
Addressing Concerns and Misconceptions
This article shows lack of insight by insinuating that we cannot discuss health behaviors without discussing weight. The conversation about the role of weight and weight management in health promotion is not as one-sided as it once was. There is too much evidence on the impact of internalized weight stigma on mental and physical health to ignore. At the same time, we are starting to see papers illuminating the ways in which health behaviors confer benefits independent of promoting weight loss. This is an admittedly controversial topic that warrants its own write up. For now, suffice to say that weight is not a positive motivator for many patients, and those patients are able to achieve the most consistency with health behaviors when they shift focus away from the scale.
The "Big Food" Factor
It’s unfortunate that the food industry “capitalized” on movements to address the pervasive shame and stigma around food and body. However, suggesting that dietitians cannot use these counseling approaches ethically is irresponsible at best and actively damaging to the mental and physical health of countless people at worst. The article’s limited exploration of how nutrition professionals implement these frameworks is alarming and misleading. Of course! Based on the above, it should not be surprising that Big Food would see the potential financial benefit of leaning into the anti-diet approach and developing partnerships with influencer RDs in order to sell their products. Industry is the original influencer afterall. Big Food has also increased their production of lower added sugar and lower sodium foods because of demand. They go where the money is. Does that reduce the value of an anti-diet approach? Probably not.
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The Real-World Perspective
We do not live in a research study, or the ivory tower of academia. We live in the real world. Here, in the real world, there is sugar sweetened cereal. There are foods that bring us joy, foods that connect us to our culture and our loved ones and our childhood - some of these foods are nutrient dense; some feature sugar and palm oil and a host of other ingredients you wouldn’t find in a home kitchen.
Ethical Considerations for RDs
RDs are trained to assess food products and are bound to a code of ethics that prevents them from making harmful recommendations. Helping support the public in achieving a more neutral relationship with food after decades of “eat this, not that,” “low fat,” “high fat,” “no fat” is not a harmful recommendation. If an RD seems to be pushing for a specific food brand or supplement and is unable to discuss alternatives, that may be a red flag. As with all things on the internet, proceed with caution and avoid taking generalized health recommendations. Concerned about which RDs are popping up on your socials?
Weight-Inclusive Health Care
Weight-inclusive health care is a non-discriminatory approach that aims to support individuals in health, regardless of their weight or body size (6). It recognizes that body weight is complex and multi-dimensional and that health is determined by many factors, including (6,7):
- Genetics
- Behavior
- Environment
- Social determinants of health
It also acknowledges that weight stigma and discrimination can have negative impacts on an individual’s physical and mental health and well-being (6). The goal of a weight-inclusive approach is to promote health, well-being and accessibility for all individuals, regardless of their weight or body size. It also encourages health professionals to examine their own biases and assumptions about weight and to adopt a more holistic approach to health (6). Applying a weight-inclusive approach may include focusing on healthy behaviors that are sustainable, enjoyable, and desired by the client/patient rather than pursuing a certain body size as a marker of success.
Benefits of Weight Inclusivity
A weight-inclusive approach can have benefits for both health professionals and clients/patients, including (6):
- Improved health outcomes: A weight-inclusive approach encourages patients to adopt healthy behaviors that are sustainable and enjoyable rather than pursuing a certain weight or body size as a marker of success. This can lead to improved health outcomes, such as the reduced risk of chronic diseases like heart disease and diabetes.
- Reduced weight stigma and discrimination: A weight-inclusive approach acknowledges that weight stigma and discrimination can have negative impacts on an individual’s physical and mental health and well-being. By adopting a weight-inclusive approach, health professionals can help reduce weight stigma and discrimination, which can improve patients’ overall health and well-being.
- Improved patient satisfaction and trust: A weight-inclusive approach can improve patient satisfaction and trust in healthcare providers. By adopting a non-judgmental, supportive approach that focuses on overall health and well-being rather than weight, health professionals can build stronger relationships with their patients and improve patient outcomes.
How Health Professionals Can Incorporate the Non-Diet Approach
As health professionals, we can incorporate the non-diet approach into our practice in a variety of ways. Here are some tips to get started:
- Educate Yourself: Take the time to address your own weight biases and learn about non-diet and weight-inclusive approaches and how they differ from traditional weight-focused approaches to health and wellness.
- Language Matters: Use language that is inclusive and non-stigmatizing when talking about weight and health. Avoid using terms like “obese” or “overweight” and instead focus on health behaviors and overall well-being.
- Emphasize Self-Care: Encourage clients to engage in activities that promote self-care and overall well-being, such as mindfulness, movement, and social connection.
- Address Root Causes and Barriers: Look deeper into root causes of health conditions and barriers to adopting client/patient-desired health behaviors.
- Focus on Health Not Weight: Look at clinical indicators of health (blood pressure, lipids, blood sugars, etc.) and use your knowledge and skills to focus on health behaviors that can address these parameters.
- Support Intuitive Eating: Help interested clients to develop a positive relationship with food by encouraging them to listen to their internal cues of hunger, fullness, and satisfaction.
- Do No More Harm: Offer compassion, acceptance, and support for people at any size. Embrace a diverse range of body shapes and sizes and celebrate the unique qualities that make each person who they are.