A Conversation with Christy Harrison
The renowned registered dietitian/"Food Psych" podcast host on her new book, "Anti-Diet: Reclaim Your Time, Money, Well-Being and Happiness Through Intuitive Eating"
On Christmas Eve 2019, former presidential candidate Andrew Yang’s plan for the future of American healthcare arrived like a deck of Target gift cards hastily snuck under the tree. “If we spent a fraction of the money we spend in our healthcare system on actually keeping people healthy it would transform everything,” Yang tweeted, in one of his typically libertarian-leaning overtures that have proven irresistible to legions of 4-Channers and Childish Gambino fans, adding, “We should be paying people to go to the gym/yoga studio/nutritionist instead of vice versa.”
Notice that he wants to pay people to go to gyms, yoga studios, and nutritionists, not primary care physicians or dentists or radiologists. What Yang advocates for is essentially an update on the personal-responsibility politics of the “War on Obesity.” Much like the War on Poverty, the War on Terror, and the War on Drugs, the enforcement of the “War on Obesity” always comes at the expense of the marginalized folks that those who enact it are claiming to liberate. In the years following 9/11, the connection was made absurdly literal by Tommy G. Thompson, the Secretary of Health and Human Services who urged all Americans to lose 10 pounds as a “patriotic gesture,” while Surgeon General Richard Carmona called obesity “the terror within.”
The insurmountable scientific evidence that sustained, long-term weight loss through dieting is nearly impossible, as well as the lack of actual causation between weight and negative health outcomes. Yet the pipe dream persists, that the populace of Jonesboro, Arkansas or Shreveport, Louisiana may one day divert their precious hours of downtime to CrossFit and roasting beets instead of binge watching Love is Blind or enjoying a McFlurry or any other affordable, accessible pleasures in their lives. Far from being disavowed by public health officials for its inherently racist, sexist, and classist underpinnings, Yang’s preventative care model has basically been the mainstream approach to weight management since the 19th century. Christy Harrison, host of the popular “Food Psych” podcast and one of the world’s most visible and vocal anti-diet dietitians and Health At Every Size advocates, once believed it herself.
“I thought very similarly to Yang,” Harrison told me during a phone conversation shortly after the release of her new book, Anti-Diet, Reclaim Your Time, Money and Well-Being Through Intuitive Eating. “If we could only help people eat better and move more, then all of these public health crises would be solved and we'd be able to prevent so many cases of disease,” she said, explaining her former line of thinking. “It’s very understandable that we think food and exercise is the be-all end-all, but it’s another lie diet culture tells us.”
Diet Culture’s greatest trick is telling us it doesn’t exist, and in 2020, it cloaks itself in the language of tech-industry liberalism — “empowerment,” “wellness,” vis a vis eating intermittent fasting or “sirtfoods” where weight loss is viewed as a happy coincidence rather than the intended outcome. While Anti-Diet primarily serves as a compilation of Diet Culture’s Greatest Lies, it’s also a personable, heartfelt memoir of Harrison struggles with a regimen of orthorexic, “clean eating” and compulsive exercise that can pass for a socially acceptable eating disorder, a feminist critique of the past two centuries of nutrition policy, and a history of diet culture’s uniquely devastating effect on female political power and solidarity.
These narrative threads all merge to bring real-life context for Intuitive Eating and also, Health At Every Size (HAES) - concepts that undo literally centuries worth of assumptions about the connection between weight and health, and also challenge the modern heterodoxy that we owe anyone our “wellness.” This shift in perspective underscores Anti-Diet’s most resonant notes, as an elegy for a bygone concept of social justice in the dietary field. Like many dietitians who got their start in the 2000s, Harrison initially saw herself as part of the cause led by academic celebrities like Marion Nestle and Michael Pollan, authors of Food Politics and In Defense of Food: An Eater’s Manifesto, both of which set the tone for the 21st century’s obsessions with farm-to-table dining, the latter coining a most frequently parroted line of well-meaning dietary advice - "Eat food, not too much, mostly plants.”
But as Harrison sees it these days, such measures have the side-effect of “demonizing people’s food choices.” Part of the greater aim of Anti-Diet is to scrutinize the benevolent wokeness that typified the Obama era, where the idea of introducing social justice to nutrition mostly meant making farmer’s markets more SNAP-friendly. Still, it’s not like Michelle Obama was diverting from the dominant thinking by dietitians on the subject. The Academy of Nutrition and Dietetics, our governing body, is still largely functioning on a weight management paradigm, a troubling trend when an international study suggested that 77 percent of nutrition students fear their classmates struggle with disordered eating.
There’s no denying that moving the field to a “health at every size” mindset will be an uphill battle. Even beyond the prevailing assumption presumption that being an “anti-diet dietitian” is an oxymoron, or convincing insurance companies that centuries worth of research on weight loss actually works in HAES’s favor, the greatest challenge Harrison sees is integrating social justice into a realm that claims to be “apolitical” — even though political action is responsible for creating equal access to food, healthcare, and legal recourse to fight against discrimination when it comes to those basic human rights. “If you just think about the fact that one political party is advocating for the shunning of social justice and human rights, that’s a really dangerous position to take,” she said. “Everyone across the spectrum should be able to get behind the idea of inclusion and social justice for all.”
What were the events that “radicalized” you, so to speak - that led you down a different path?
The first thing was moving into the eating disorder field. When I first started, I was working in the [New York City] Department of Health and Nutrition Policy Initiative, and I did the Pollan/Nestle thing, trying to bring fruits and vegetables to lower income communities, educating people on eating fruits and vegetables, trying to change what was being served at schools and hospitals. I loved the work and the people, but I was feeling creatively unfulfilled, that part wasn’t being satisfied. So I started Food Psych in 2013, while still finishing up my internship hours. Pretty quickly, I learned that was the field I wanted to specialize in when I started my private practice.
I learned about HAES in 2010 when I was guest editing a package for at Slate, "ending the obesity epidemic." I had spirited conversations about HAES vs. the weight loss paradigm, I bought the Health At Every Sizebook and the Fat Studies Reader and leapt into the stratosphere. But they were sitting on my shelf and not really doing anything, until I started working in eating disorders. I encountered it at conferences as the gold standard for recovery, a paradigm to help our clients recover that was truly supportive of full recovery and not this trigger back into disordered eating.
Like most health care professionals coming out of the weight loss paradigm, it didn't totally change my practice right away. I was doing HAES with my eating disorder clients and weight loss with my others and didn't see how the two were incompatible. I learned by delving further into the literature and conferences that social justice was the missing piece - weight stigma is harmful to people's health, independent of body size and that if we are colluding with weight stigma and cosigning the desire to lose weight and giving weight loss advice, we're perpetuating stigma and causing real harm.
Were there clients who initially rejected Health at Every Size?
It was a gradual transition. I was taking on weight loss clients as I was transitioning in my own career, trying to be open with them - “hey, i'm switching focus in my new practice, do you want to try this new thing? Do you feel comfortable putting pause on the weight loss focus?” Intuitive Eating was a big part of my practice all along as well, it’s one of the five principles of HAES, we're working on getting people in touch with their [hunger and fullness] cues and not focus on weight and eating for external reasons. Some people came along, some didn't. I saw resistance with the eating disorder clients at the time, because when you're in an eating disorder, it's the polar opposite of HAES, it's being completely in diet culture. It was challenging with some folks, but for others, it was a missing piece of their recovery that they didn't know they needed. And once they were introduced, it was this light bulb moment. I tell one story in the book about this client "Sushi Pizza," there's a whole explanation of the nickname. She was already a social justice-minded person, she believed in equality and feminism and anti-racism, so it was easier for her to grasp that body size was just another form of oppression that we need to fight. She'd been in and out of treatment centers for half her life for very severe anorexia, the kind of person you'd think of in some ways as the stereotypical picture of an eating disorder. You would think that would make her resistant to HAES, but it resonated so deeply with her and it brought her to the next level of recovery, it’s still a touchstone in difficult moments.
Do you feel that the Academy of Nutrition and Dietetics has been hesitant or even resistant to HAES?
HAES is more in line with the Academy's stated values than weight loss - you've got the All Foods Fit approach, which is a stated value of the Academy since forever and HAES is all about that. We don't tell people to cut carbs or restrict their eating window. We are also using an evidence-based model of care, but there's still some “controversy” around it. A couple of years ago, I spoke at FNCE [ed. note - Food & Nutrition Conference & Expo, essentially the dietitian Coachella] about HAES and it was framed as a debate between weight management and HAES. That was the only way that it was allowed to be part of the program. That's where we're at with the Academy right now. They may perceive it as a threat even though it shouldn't be. It's HAES dietitians who are doing the [Academy] mission in a way that is truly ethical, helping prevent and reduce weight stigma in the world, engaging in behaviors that are truly health-promoting and are evidence-based in themselves, whereas weight management has a very shaky evidence base that isn't an evidence base at all. We have many studies that have a correlation between high body weight and poor health outcomes, that make a cognitive leap that says higher weight causes them. But we don't have science that shows causation. What we do have is evidence that weight stigma is a risk factor in and of itself and that can explain much or all of excess risk for certain diseases and health outcomes. And the same thing with weight cycling independent of body size, it's an independent risk factor for things that get blamed on weight, like blood pressure, diabetes, mortality rate. Focusing on weight itself is actually detrimental, we know from research they end up weight cycling and ultimately regain weight the vast majority of the time. If we're prescribing something that's causing harm, we're doing something that's antithetical to the Academy's code of ethics. To me, HAES is the only ethical, evidence-based model of care, and really all I'm doing is taking weight out of the equation - it might go up, it might go down, it might stay stable, but let's focus on behaviors that healt-hpromoting and evidenced-based that we know can help you, to the extent that you desire and choose, support your health.
As one of the more prominent voices for HAES, have you experienced backlash or even threats?
I have received some surprising backlash, it can get pretty heated and there are times when it's ugly. I’m not a person who actually likes conflict whatsoever, I'm horrified by all of it. From dietitians and other health professionals, it's pretty respectful, [the backlash] is from the people who don't actually have credentials or work in this field at all but have strong beliefs about particular diets - proponents of various fad diets, I'll just say - who are the most vitriolic and upsetting in how they come at me. But I will also say that my colleagues in larger bodies bear so much more of the brunt of people's hatred and than I actually have thus far, knock on wood. No one deserves this kind of hatred, but I have not had the kind of stress and scary interactions that my colleagues in larger bodies have and I think that's because i'm protected by thin privilege, which is a product of diet culture that creates a stigma against larger bodies. It’s this countervailing privilege for people in smaller bodies to not be as targeted.
Amongst the many -isms in our society, you talk about "healthism," the argument that health should be everyone's foremost priority and the judgment of people who are not “healthy” as morally inferior. How open are people to really challenging that?
The healthism argument is the hardest for people to get their head around because we go into this field because we value health and nutrition. We're told they're the major, if not the sole, determinant of people's well being. That's definitely what I thought when I went back to school to be a dietitian and even before when I was writing about food and nutrition. That's part of diet culture, a belief that's' been instilled since the turn of the 20th century - it's always there, “we need to eat less and move more to change the size of our bodies,” or "be healthy." It was there in the 80s and 90s and the 50s and earlier on, there's so much building up to that, which I discuss in the book. Now, diet culture has gone underground and tried to morph itself into a lifestyle change - "it's not about weight, it's about wellness. P.S., you'll lose weight as a side effect." So it's understandable that so many of us believe that exercise and food are the main determinants of health. But social determinants have so much more impact on people's health outcomes than individual health behaviors - I learned this back in grad school for public health and promptly filed it away in a shelf on my brain because I didn't have the framework to understand it. There's evidence that 70% of modifiable determinants health at the population level are due to social determinants like racism, poverty, food insecurity, discrimination, environmental impacts of living in low-income areas, things that we have no individual control over. But as a society, we can change that together - it's so much bigger than food and movement, only 10% of our modifiable health outcomes are due to food and exercise and another 20% are other health behaviors. If we really want to improve public health, we need to focus on the social determinants instead, knocking out 70% rather than harping on than the 10% that is food and movement. The way that we're being told to eat and move our bodies is inaccessible and impossible for the vast majority of the population in large part due to these social determinants of health keeping people from food or spaces to move their bodies, or having the time available for the labor or the money to spend on physical activity spaces or the desire or mental bandwidth to deal with that stuff instead of the day-to-day survival tasks. It's very understandable that we think food and exercise is the be-all end-all and t's another lie diet culture tells us, we don't look at the real causes that include weight stigma and diet culture itself. It's easier to say “eat less!” than it does to say, “let's end systemic racism!” Telling people it's their personal responsibility is more harm than good, it's gaslighting them - it's telling them that their health is solely in their hands when it's not.
Let's suppose the next presidential administration puts you in some sort of high profile position in the Department of Health and Human Services, what are the ways to advance the cause of HAES on a policy level?
I hate to say it because I love the Obamas in so many ways, but I think it would be reversing some of the things they did, like Michelle's “Let’s Move” campaign or some of the things from that era for quote-unquote obesity prevention. It's not just the Obama era, this goes back to George W. Bush and his Department of Health and Human Services, it was Tommy Thompson who said obesity is an equal threat to terrorism after 9/11. For me, it's reducing funding or, in a perfect world, eliminating funding for obesity prevention and reduction and instead channeling that money towards programs and research addressing the social determinants of health, programs and research addressing weight stigma to prevent and reverse weight stigma and disordered eating, changing the rhetoric around public health to acknowledge how wrong we've been and how the research has not borne out the approach we've been taking in food policy - that Pollan/Nestle approach to food politics that demonizes people's food choices and makes it their personal responsibility to quote unquote make good food choices. Demonizing food companies hasn't really gotten us anywhere and this war on obesity has been far more harmful than helpful. We need to make HAES the official policy of the United States and it's so insane to say but it's my dream.
In any social justice movement, besides the resistance it faces from the outside, there are internal conflicts and “purity tests,” do you see those arising within HAES?
I think there's two ways to look at this - there's the way outsiders look at it where they'll see people who are ostensibly HAES arguing with each other about who's pure or not and that's a red herring. What I see within HAES is that the people who truly get it and understand the social justice import of reducing weight stigma and celebrating size diversity in all forms don't have those kind of rifts. It’s the people who are on the fence and are still doing weight loss and not understanding the deep importance and ethical requirements of doing HAES fully and practicing it without offering weight loss on the side. It's those people who are fighting a lot of times. You can't really get over the fence in this culture if you don't straddle it for a while, there's no way to teleport through it. I do see people get stuck in that straddling place and dig in their heels and say “I'm allowed to sell weight loss and do HAES!” If there's any sort of true...I wouldn’t even say conflict, but internal discussion from people who truly get it, it's in the importance of social justice and the nuances of that. A lot of us in the HAES movement are white, cisgendered women, that's who a lot of dietitians have usually been, a lot of therapists as well, that’s the heart of the movement thus far. There's areas that we don't see as white, cisgendered women and also many dietitians especially are thin, able-bodied, white cisgendered women. There are places where we need to be brought into awareness by others in the HAES community who are more marginalized and who have that perspective that we lack as privileged people.
What are the barriers to increasing diversity within the Academy?
There's a couple of key areas. I think one is reducing weight stigma from the Academy, reducing weight stigma within the profession. I've talked to a lot of dietitians in larger bodies and I see more and more going through the program to become dietitians and more early-career dietitians in larger bodies who've been inspired by the HAES movement and listen to the podcast and felt empowered to pursue a career. But it's incredibly hard and triggering and painful to sit through the classes on weight loss and to endure the constant low-level weight stigma that simmers amongst their classmates and so that's a huge barrier. If we had more people in larger bodies in this field, there'd be an inevitable broadening of perspective, of the lived experiences of living in a larger body, how impossible long-term weight loss is for most people and how difficult it is to move through the world because of weight stigma. The other piece is making it affordable, because as it is now, you have to do an unpaid internship, you have to do a full undergrad course load and now there's a masters requirement [beginning 2024], who is able to do that? I have massive, massive student loans - but if you are able or privileged enough to take those on and think, "oh I'll deal with it later," that was my experience and I wish I had been a little more savvy. If people are trying to work through school, it's really difficult - they end up dropping out or don't even attempt it because it takes so much privilege to be able to do that, to go through all the schooling and the unpaid, full-time internship. Who has the resources? Because most people are not getting student loans, they're maybe able to get private loans. Independently wealthy people with support from their families are the majority of the people I see being able to take it on.
Is there a risk of bringing concepts of social justice into a therapeutic field, given how some clients of more conservative political beliefs might feel attacked or alienated?
That makes total sense, but we have to center the most marginalized people in our efforts to do health care in an ethical way and that sometimes makes privileged people feel attacked and feel defensive. It’s a byproduct of white supremacy and patriarchy and all these oppressive systems that result in the health disparities that we see in marginalized identities. It has to be a discussion within a group milieu in a treatment setting, that here are our policies as a treatment center: we're gender-inclusive, we have non binary people in this program, we have trans women, we have people of color and we want this to be the safest, most inclusive space as possible for everyone. There's no such thing as a 100% safe space, but we need a brave space to have discussions about these issues and the harms that occur, we want to support people no matter their background. If people in privileged identities have an issue with it, it's important to have that discussion, “what about this is threatening to you? What feels triggering or challenges you about having this be a space that encompasses transgender?” Maybe that's a question for their individual therapist as well as a group setting. We want to make sure that people aren't being given space to say really harmful trans of homophobic or anti-black ideas in a group setting cause that would be detrimental to the marginalized people who are there. In order to help everyone recover, we really do have to center the marginalized and when we do that, we can uplift everyone.