Demons Under the Dinner Table: The Impact of Diet Culture and Weight Stigma on the Black Community

Weight stigma stems from diet culture. Diet culture contributes to the development of poor body image, disordered eating habits, and has been shown to take a toll on mental health (Carrotte, Prichard, & Lim, 2017). Weight stigma and diet culture are rooted in narrow-minded body ideals that can be traced back to slavery (Strings, 2019). Both have been a breeding ground for demons under the dinner table. Contrary to popular belief, weight loss is not the answer to ridding the Black community of these demons. The way to annihilate them is to attack them at the core. This can happen by shifting the focus to rectifying the detrimental effects of diet culture and weight stigma.

It has been suggested that diet and exercise for weight loss are the answer to the health issues that are assumed to automatically come with being in a larger body. However, there is evidence that weight stigma is more damaging than the weight itself (Carrotte et al., 2017).

Weight-based stigma

Research suggests that weight stigma predicts mortality more than any other form of stigma (Sutin, Stephan, & Terracciano, 2015). Studies show that weight-based stigma negatively affects health, equal access to employment, earnings, education, and medical care (Puhl, Lessard, Himmelstein, & Foster, 2021). Many African Americans already face unequal treatment regarding these issues. Weight-based stigma adds an extra layer of discrimination to fight. The Black community is commonly identified as having the highest prevalence of obesity, therefore it is likely Black people will experience weight-based stigma and discrimination. Pointing the finger at weight or body size as the main cause for diseases such as heart disease and diabetes contributes to the propagation of fatphobia within the African American community. Public health messages contribute to the harmful effects of diet culture and weight stigma. These effects may be unintended but have harmed the Black community (Tomiyama et al., 2018). Perceptions of the health risk of obesity and promotion of weight-normative policies affect the culture of health by influencing the formation of healthcare practices and policies. The stigma and prejudice associated with these policies create stress, illness, and barriers to healthcare. Healthcare providers have a responsibility to be mindful of the messages passed along to clients, patients, and the general public. Weight loss is not the answer for diabetes, cardiovascular disease, inflammation, or other related diseases. It is not the answer for disordered eating habits or an eating disorder (this might sound obvious, but it is not as well-known as one might think).

A weight-inclusive approach

There is a body of research that supports and aligns with a weight-inclusive approach to healthcare (alternate approaches, e.g., Intuitive Eating and Health at Every Size; Bacon, 2021). A weight-inclusive approach would focus on teaching balance, eating for well-being, and how to take care of the body without the meticulous obsessions fueled by diet culture. This includes listening to the body’s needs and eating accordingly, rather than following the ‘shoulds’ and ‘should nots’ brought about by various nutrition fads and trends. Honoring the body’s needs in the absence of the stress of weight stigma and fatphobia can decrease stress on the mind, which would lead to a decrease in production of stress hormones and inflammatory markers in the body. Stress hormones and inflammatory markers are known to be the cause for many of the diseases we attribute to obesity and fat. In addition to the physical health effects, there are also mental health effects to take into account. Black folks have had to navigate the beauty ideals of a white dominated, Eurocentric culture for centuries, in addition to navigating the ideals of their own culture. The vast differences between the two ideals can be difficult to reconcile and make the promises of dieting and weight loss seem like the answer to an impossible problem—thus, causing an internal and enduring body image struggle because of one’s external appearance.

Restoration of balance is necessary for Black folks to prevent and heal from the diseases that have been brought on by centuries of diet culture, weight stigma, and fatphobia.

Focusing on weight loss to improve health is known as a weight-normative or weight-focused approach to healthcare. The weight-normative/weight-focused approach brings about mental health impacts that have the opposite intended effect (Tomiyama et al., 2018). Physical damage is done to the body in addition to mental health impact. This includes metabolic injury and other effects of weight cycling. A weight-inclusive approach reduces stress because it is more well-rounded and does not focus on weight as the main indicator of health.

Mistrust of the medical community

Health promotion in the African American community has been similar to health promotion across the board. The idea that if one reaches a healthy weight through diet and exercise, they can solve most, if not all, of their health problems. The Black community has had a complex relationship with healthcare practitioners and the healthcare system. African Americans struggle to trust the medical community. This is a result of the trauma that has been inflicted on Black bodies throughout history: slavery, racism, objectification, abuse, and medical experimentation. Some of this trauma continues today. In addition, if someone goes to the doctor to be seen about a problem unrelated to weight, but then receives a lecture about how they need to lose weight, they are going to avoid the doctor as much as possible. Many individuals avoid the doctor for fear of judgment and discrimination that accompanies weight stigma (Puhl et al., 2021). Combine that with the mistrust of the medical community that African Americans have understandably developed over time, and there’s a high risk that minor health conditions will go untreated, worsen, and become major health issues that could have been avoided or treated at a much lower cost. Research also suggests that those who experience weight stigma are less likely to be motivated to engage in health-promoting behaviors (Vartanian, Pinkus, & Smyth, 2018).

How does one address this as a clinician?

• Remember that healthcare providers have a responsibility to do no harm
• Be mindful that stigma of any kind undermines a culture of unity
• Take a stance of compassion and empathy by advocating for and protecting those who are marginalized from the effects of prejudice, stigma, and discrimination
• Take action against weight-based stigma and fatphobia, including helping clients foster a neutral, accepting, or positive relationship with the body
• Help clients develop an appreciation for different types of bodies

This may require some examination of your own biases and the relationship you have with food and your body. Other ways include reduction of stress and normalizing mental healthcare within the African American community, which includes education about disordered eating, eating disorders, and weight stigma, advocacy and allyship for marginalized clients and those within the Black community, and providing referrals to useful and relevant resources. Be mindful that oftentimes clients express that it feels most beneficial to have interactions with providers to whom they can relate, who have similar lived experiences. One way to do this is to build a toolbox of resources for marginalized folks.

Although diet culture could point to a one-size-fits-all solution to the health disparities in the Black community, one weight range or size category is not the answer. Diet and weight loss are not the weapons needed to fight the demons lurking under the dinner table. Taking a closer look, one can see that diet culture and weight-based stigma are at the core. In mythical folklore, devils and demons are typically a threat to the world in which they exist. They act in opposition to the heroes and gods who are tasked to vanquish them to restore balance. Restoration of balance is necessary for Black folks to prevent and heal from the diseases that have been brought on by centuries of diet culture, weight stigma, and fatphobia.