Towards A Diet-Free Revolution
Dr. Alexis Conason began her career as a clinical psychologist with a goal to help people lose weight.
When she was introduced to the concept of Health at Every Size, she experienced a paradigm shift which she shares in her new book, The Diet-Free Revolution. This book encourages us to take agency over our own bodies and exposes the Diet Industrial Complex as an industry that thrives on its own failure. The Diet-Free Revolution will be a game changer for people dealing with body size issues, including many women past midlife.
Stella: Alexis, what was your process like, in moving past Diet Culture to become an advocate for mindful eating and agency over our own bodies?
Alexis: Food was my companion as a child, a source of comfort. But as an adolescent I became convinced that dieting was the answer to my unwanted curves. As kids when we are powerless over so much in our lives, food is one of the few resources we have to take care of ourselves; it’s a sign of resilience. But at the time I didn’t see it that way. I saw it as a source of shame and something to change. I was caught in that dieting cycle for decades, so caught up that I went into the field of psychology hoping to solve the issue, for others and myself. At the time I was framing the issue as how to make myself smaller.
Stella: And then how did your perspective shift?
Alexis: It had never occurred to me that there was another way to look at this issue. I made it all the way through my doctoral program and post-doc with a traditional mindset. Then I attended a Mindful Eating seminar which itself had been corrupted by the diet industry and was focused on weight loss, and at the time I thought there was nothing wrong with that. But there were some Health at Every Size people at the seminar. I remember having a conversation with one person who said, “But of course we know dieting doesn’t work.” And I thought, what are you talking about, of course dieting works. It works for everyone. The fact that I can’t work it is a problem with me. But then I began to think, maybe I’m not the problem, maybe the system is the problem. And I was seeing with clients too, that the more they dieted the more out of control they felt about food and the more they blamed themselves and believed that dieting would be the solution even though it wasn’t working. I changed to focusing on healthy behaviors rather than body size, which is not a behavior. There are so many layers to all this including learning more about intersectionality and body size. I’m still learning!
Stella: There is so much to learn, including about the natural variety of body sizes and shapes, and how important that is. One idea that really struck me in your book was your emphasis on our bodies being amazing and taking care of us, even if they aren’t doing exactly what we think we want them to do. Tell us about your concept of collaborating with our bodies.
Alexis: Fighting against our bodies is not working. That is one thing I feel really deeply for myself and my clients. It’s just exhausting to be fighting yourself all the time. This idea that we have to fight against our body because some diet doctor on television tells us what to do makes no sense. If we can make peace with our bodies and recognize that it is a collaboration, we can work together, feeling the best we can, mentally and physically.
Stella: And when we fight with our bodies we lose our agency and our power.
Alexis: When we spend our resources of time, energy and finances fighting our bodies and experiencing shame that makes us want to run and hide our bodies instead of fully experiencing our place in the world, it disempowers us. When we buy into the Diet Culture concept that we are less-than, we take ourselves out of the game. What if we devoted all that energy to the causes that are most important?
Stella: Exactly. That ties in with your discussion of Maslow’s Hierarchy of Needs, and how Diet Culture keeps us stuck on a low level of that hierarchy.
Alexis: Abraham Maslow was a psychologist who believed we had different levels of needs and it is difficult to satisfy our higher level needs if our basic needs aren’t met. The basic needs are things like food, shelter, safety and health. Someone who is starving or who is without housing may not be able to think as clearly about things like relationships, creativity, and self-actualization. Diet Culture keeps us trapped at the base of the pyramid. We don’t have a sense of security around food. Even if we have access to food, we may not give ourselves access to food. We stay focused on food and hunger instead of being able to move forward with things like creativity or social activism. Diet Culture robs us of our agency.
Stella: There is a lot of money to be made from the failure to accept ourselves. One of the themes that struck me in your book was how that very wealthy diet industry has used its resources to influence government policy, for example tightening the categorization of “obesity” without good scientific evidence.
Alexis: My years as an “obesity researcher” really came in handy because I got an inside peek into the decision to lower the BMI cutoff for “obesity.” We hear so much about how “obesity” rates have skyrocketed. But the reality is, they changed the benchmarks. I use quotes because the term “obesity” is stigmatizing and I try to avoid it. The AMA classified “obesity” as a disease even though their own advisory board said the evidence was not there to support that classification. But if you look at the people who overrode that decision, they all had deep ties to the weight loss industry. Not coincidentally, there were two weight loss drugs up for FDA approval at that time, and the classification of obesity as a disease would help gain insurance reimbursement for these drugs. People tend to think an AMA decision must be based on science and in the interests of patients. But some of these decisions are in the interests of industry.
Stella: I worked in biotech for many years and am familiar with the FDA Advisory Committee recommendation to approve FenPhen, a combination drug that killed a lot of people before it was taken off the market. The committee members all disclosed ties to pharma companies in the weight loss space, and their risk/benefit analysis of troublesome data seemed based on the assumption that any risk was better than being fat.
Alexis: Another medication called lorcaserin (trade name Belviq) was recently taken off the market in 2020 due to cancer risk. There were questions about safety even when the FDA initially approved the drug in 2012. The outlook seems to be almost that dying is better than being fat. The way bariatric surgery is recommended is similar. The risks are so underreported. People are eager to grasp at anything because it’s so difficult to live in a larger body in this culture. We seem to ignore the risk to life and to quality of life.
Stella: And then paradoxically repeated dieting can lead to a higher set point.
Alexis: These are the kinds of things that get discounted in weight science. People say it is unhealthy to be fat, but is that the cause, or is it unhealthy to live a life of weight cycling? Is it unhealthy to live as a stigmatized person in this culture? We know from studies of other stigmatized groups that the impact is really profound. And there is the impact of not being able to get adequate medical care due to stigmatization by medical professionals. There is so much left out of weight science. In an area that is highly funded by NIH and other sources, it’s surprising how sloppy so much of the research is, especially in not controlling for confounding variables.
Stella: And some researchers have closed their minds to new ideas in an unscientific manner. Dr. Katherine Flagel, a senior CDC scientist, published a peer reviewed article showing that “obesity” was associated with a lower than expected increase in mortality, whilst “overweight” was associated with a lower mortality than “normal” weight. This conflicted with the accepted wisdom and Flagel was subjected to a campaign of insults, misinformation in the the press and complaints to her employer from scientists invested in the weight loss narrative. It is interesting to note that Dr. Flagel is a woman and the scientists behind the attacks are men. I loved your quote from Naomi Wolf: “A culture obsessed with female thinness is not an obsession about female beauty, but an obsession about female obedience.” Recognizing that weight stigma affects all genders, it does seem like women are targeted by the diet industry. This is a place where the personal really is political. For women past midlife, when many women are larger than the cultural “ideal”, weightism, ageism and sexism intersect.
Alexis: Whenever we talk about the policing of women’s bodies, it’s a political issue. Research shows that 90% of women struggle with body image. That’s not an individual issue, that is a cultural issue where an entire group of people is being targeted. An entire culture is invested in having women believe that we are not good enough, that our value is based on what we look like, then posing an unrealistic ideal and saying if you don’t meet this ideal, there is something wrong with you. Then you are supposed to spend all your time and money to meet this impossible ideal, so you feel like a failure and are too busy to pay attention to what else is going on.
Stella: Yet the diet industry is built on its own failure. We believe that the failure of that industry is our own personal failure.
Alexis: That’s the biggest hoax of all. I have clients who say, I did really well on this diet. It really worked for me. And so I ask, why are you here in my office if it worked so well? And they say, I got lazy, I didn’t have the discipline, I need to do better. We blame ourselves even though we know that for 95% of people, dieting won’t work for even two years, and we get stuck in that weight cycling. And yet we think that we are the exception. If we just could do it better….
Stella: If someone says I lost my focus on this program, it probably means they were doing something more important—learning French or raising children. And yet they are blaming themselves for spending time on a higher level of Maslow’s Hierarchy.
Alexis: It’s like we shouldn’t be living our lives, we should only be focused on dieting. Studies of those unusual people who do succeed at dieting show these people are consumed with counting every calorie, with exercising two hours a day. This is their entire life. At what cost are they succeeding?
Stella: I wanted to check in with you also about advocacy. If people get to a point where they want to focus on self-empowerment and move past dieting, there are so many messages we still receive from doctors, colleagues and friends. When men get together for lunch, they often talk sports, bonding about celebrating the male body. When women get together for lunch, they talk about how terrible it is that they’re eating this food, which is bonding about denigrating the female body. How best to deal with this?
Alexis: The more we progress on our own journey of self—acceptance, the more you hear all the comments of friends and colleagues in a different light. Living in New York, you hear a mother saying to her daughter, we’re going to be bad and share this croissant, or lamenting, I need to buy this constricting undergarment because my belly is too big. It’s really hard when you are on this journey and the people around you are not. And then it’s more challenging when your partner makes a comment, or you are at a business lunch and want to talk about substance not French fries. But to live in a marginalized body and try to educate people around you can subject you to extra scrutiny. So it’s a very individual decision about whether and when to do that. If you have the emotional resources to share why you’ve opted out of Diet Culture and how harmful that culture is, that’s amazing. Each person who shares has the potential to reach others around them, just like the person at the Mindful Eating conference reached me all those years ago, with something really simple that can let them know there is a way out of that harmful cycle. But it’s also OK not to do that and just walk away in order to protect yourself.
Stella: Could you give us a brief overview of the ten step program in your book?
Alexis: There are ten steps in the program but I think of it as three phases. The first is accepting that dieting does not work. This involves looking at the research but also the immediate concerns that come up about health. And what we see is that dieting is not healthy. It has a whole bunch of risks and not a lot of benefits. Once a person has accepted that dieting does not work, then we can begin to listen to our bodies more. And that is tricky when we have spent a lifetime fighting against our bodies. We might think that once we give up dieting we will sit on the couch eating donuts all day, which is a concern I hear frequently. It’s scary to trust that your body will lead you in the right direction. I try to create a very structured program for how to listen to our bodies. I pull a lot from mindfulness, which strengthens the connection with our bodies. The communication system may be disrupted, where our body is trying to send us information and it’s hard for us to hear because we have ignored those signals for decades. We pay attention to how different foods make us feel, how to make choices and know what we want to eat. After that I talk about understanding our emotional experience with food, which is important, because if we are constantly using food to cope with our feelings then we may wind up with emotional needs that are not fully met. I explore other tools to cope with our emotions. And then at the end I talk about what we do with this extra time and space, now that we are not punishing our bodies. How can we connect with our bodies in terms of pleasure, the pleasures of food and sex and movement? How do we reclaim the pleasure that Diet Culture stole from us? And what else will we do with our time? What are the values we want to support?
Stella: It makes sense that it would take time to develop additional ways to enjoy ourselves. And enjoying a variety of experience is so important.
Alexis: Diet Culture makes it tough to take a broader view, and to believe we are deserving. And I think people in the US are drained and depleted in other ways, such as getting enough sleep, in part because we work so much. If we have no free time and we sit down at 9 PM and eat something and watch TV because it’s an easy way to feel good, that’s not always nourishing, if we don’t have time for other choices to meet our deeper needs.
Stella: It seems like fat people can be stigmatized for going to the gym, which makes no sense even from the standpoint of Diet Culture.
Alexis: You can be told you’re lazy if you stay home from the gym or be harassed if you go. For many people who have a conflicted history with exercise, moving for enjoyment can seem very strange. I had always seen exercise as something I had to do as punishment for not being good enough. It was a radical idea to move in ways that were fun, that were gentle. I often say movement because the term “exercise” can carry a Diet Culture connotation for some people. I found my way back after years of being sedentary. I had a personal trainer who said if you don’t exercise this many hours per week you won’t lose weight and there is no point. I came back to dance as a means of self-expression.
Stella: There are so many reasons to move our bodies. You also use meditation as a key in your program.
Alexis: Mindfulness is about becoming fully aware of the present moment and what is going on within us. It changes our relationship not only with food but also with ourselves. Often we are eating on autopilot. Sometimes we are so conflicted about food we just want to get it over with. Mindfulness helps us turn up the volume on our internal guidance system and helps us with self-acceptance and self-compassion. These are really important parts of the journey because when we are caught up in hating ourselves, we don’t get anywhere. And keep in mind that how we feel about our bodies can affect how our children and grandchildren feel about their bodies. Keep in mind too that Diet Culture is sneaky. As people began to realize that dieting does not work, the diet companies rebranded themselves as “wellness” companies. Some even advertise themselves as “anti-diet.” Yet it is the same diet message with a new label. Statistically speaking, this does not have good results past the honeymoon phase.