Body Positivity in Dietetics Practice
By Carrie Dennett, MPH, RDN
Today’s Dietitian
Vol. 25 No. 1 P. 36
Is weight management one of the clinical applications?
“Body positivity” is a buzzy catchphrase popular with Instagram influencers, advertisers, and diet companies. But the origins of the body positive movement run much deeper than its current commercialized manifestations. Body positivity has its roots in late 1960s social justice movements created by and for people in marginalized bodies—particularly fat, Black, queer, and disabled bodies—to talk about the oppression they experience in society and fight back against discrimination in the workplace, doctor’s offices, and other public settings.
Flash forward to 2012 when influencer culture began to take hold of the idea of body positivity, first with plus-size influencers using #BodyPositive and #BoPo on social media, followed by thinner influencers who tended to focus on loving themselves despite body “imperfections” such as cellulite, then finally by corporations that wanted to capitalize on the trend.1 The original body positive movement was about stopping appearance-based oppression, but the more modern manifestation is about expanding what’s viewed as beautiful. Not the same thing.
“It really turned into something very different,” says Kimmie Singh, MS, RD, owner of Body Honor Nutrition in New York City. “It’s turned into something that’s quite watered down,” Singh says, adding that today’s body positive movement largely embraces bodies that aren’t really thin, but are still straight size. “They can buy clothing in regular stores and don’t face discrimination at the doctor’s office.”
The idea of body positivity in its various forms has been gaining traction as more people are rejecting the idea of weight loss, dieting, and society’s beauty and body standards. This has led to two interesting outcomes.
One is that the body positivity movement has been criticized for “normalizing” or even “glorifying” being “overweight” or “obese” and that being “too” body positive could dissuade people from losing weight and that this would impair their health.2 However, this argument ignores the health impacts of externalized weight stigma—the directing of weight-biased attitudes toward higher-weight individuals—a systemic and societal problem, and the internalized weight stigma that can follow.
Evidence of the psychological, behavioral, and physiological effects of internalized and/or externalized weight stigma continues to grow. Its negative impacts include depression, anxiety, low feelings of self-worth and self-compassion, body dissatisfaction and disordered eating, and real or perceived social isolation. Weight stigma also can make individuals believe they have low self-mastery and self-efficacy, which reduces motivation to engage in physical activity or other health-promoting behaviors. It also leads to avoidance of preventive and treatment health care.3
The other outcome is that body positivity has been adopted—some say co-opted—by the weight loss industry as part of its adaptation to the growing nondiet movement. For example, one website for a weight loss medication says that body positivity is improving our self-esteem about how we look, and lists buying clothes that fit; cooking and eating nourishing, healthful meals; avoiding body comparisons; and being physically active as ways to practice body positivity while trying to lose weight. One surgical weight loss website says bariatric surgery is most effective when accompanied by positive body image, and that body positivity, which it defined as rejecting the idea of the “perfect” body in favor of celebrating diverse shapes and sizes, can help people develop healthful eating and exercise habits.
While all of the behaviors mentioned can be aligned with body positivity, yoking them to weight loss is, at least on the surface, counter to both the original intention and the more current manifestations of the body positivity movement.
Body Positivity and Weight Loss
So, can body positivity—and actively working to build a positive body image—be compatible with intentional weight loss? Can someone feel positive about their body and want to change it at the same time? Those are complicated questions.
“It’s really important that each individual is able to decide what to do with their body, and that includes whether to pursue weight loss or not,” Singh says. “That’s body autonomy, but it’s not part of body positivity, and I think it’s important that people be OK with that difference. Pursuing intentional weight loss is so far from something that’s neutral. Fat is so charged because of fatphobia, so pursuing weight loss isn’t really something that’s body positive.”
Christine Byrne, MPH, RD, LDN, a Raleigh, North Carolina–based private practice dietitian who focuses on eating disorders and disordered eating, says she doesn’t think it’s the dietitian’s role to tell people how they feel—or should feel—about their bodies or about intentional weight loss. “Perhaps some people are able to cultivate body positivity while also working towards intentional weight loss. That said, I don’t think it’s compatible for us as dietitians to promote body positivity while also promoting or supporting intentional weight loss,” Byrne says. “Body acceptance is key to body positivity, and that means accepting and respecting all bodies as they are.” She also emphasizes that because long-term weight loss isn’t sustainable for most people, when a client fails to lose weight or regains any weight they do lose, this can undermine their body image.
“I think you can acknowledge your desire to lose weight while actively working towards body positivity; however, I think that actively pursuing weight loss while actively trying to improve body image can be counterproductive for a lot of people,” says Kristin Jenkins, MS, RDN, a Maryland-based dietitian at Rebecca Bitzer and Associates. “Intentional weight loss focuses on changing our outward appearance instead of changing mindset. It’s extremely difficult to cultivate a sense of body respect and acceptance if you are actively working to change it based on the belief that something about your body is wrong.”
Caitlin Beale, MS, RDN, a nutrition writer, and owner of Caitlin Beale Wellness in Sebastopol, California, says that, in her experience with clients, weight loss and body positivity can be compatible, but it’s challenging. “The connection between weight and negative body image or shame about weight runs deep. It’s everywhere, and it’s really challenging to separate the two.” One factor is whether the desire to lose weight only comes from a place of restriction or self-hatred instead of what someone can do to feel good in their body. “Focusing on the why is so important. I find that weight loss becomes a secondary outcome when the why steps away from the scale. You’re working on feeling better in your body because you love it and want to feel your best instead of responding to a negative voice linked to shame and body hatred.”
Weight Loss as a “Side Benefit”
When someone is practicing behaviors born out of body positivity or positive body image, it is, of course, possible that weight loss might happen. This has led many people—including dietitians, therapists, book authors, and influencers—to promote the idea that it’s possible to “love yourself thin.” This could be a problem.
“There’s so much harmful messaging out there about how loving your body—or healing your trauma, or working towards some other kind of self-growth—will lead to weight loss, and it’s just not true,” Byrne says. “It’s also incredibly stigmatizing to larger bodies because it suggests that gaining weight or being at a higher weight means there’s something wrong with the relationship you have with yourself. Sure, learning to respect, accept, and care for your body could lead to weight loss. It could also lead to weight gain, or your weight might stay pretty much the same.”
Singh says these kinds of messages can be confusing to patients because it paints their body positivity as conditional, as if they can’t love their bodies unless they lose weight. “It kind of holds on to that common narrative and trope around fatness, that you can’t be a complete person if you’re fat, that you can’t live your best life unless you lose weight,” Singh says. She adds that pushing the narrative that fat people are fat because they’re holding onto trauma is harmful because it further traumatizes people.
Jenkins also believes that promoting the “love yourself thin” narrative is misleading. “While some people lose weight, others will gain weight, and still others’ weight will not change at all,” she says. “I see this as an opportunity to challenge the belief that a well-cared-for body is a thin body because healthy bodies come in all shapes and sizes.”
Looking Beyond Body Positivity
One problem with today’s “watered down” version of body positivity is that it has become synonymous with “body love,” sometimes in a “toxic positivity” way—as if something’s wrong with you if you don’t love your body. That has led many dietitians to reject the term in favor of “body neutrality,” “body respect,” or “body acceptance.”
“I don’t use the term ‘body positivity’ with clients because the idea of loving one’s body or feeling positively about it feels out of reach for many people,” Byrne says. “‘Body respect’ is a term I use with clients to describe acts of caring for their bodies—like nourishment, movement, and sleep—in a way that feels good.”
“I’ll throw around a few different terms and see if that resonates with where they are and where they want to be,” Singh says. “I’ll even encourage people to explore analogies that resonate with them. People are so often used to people having ideas pushed on them. I find it helpful to remind folks that body positivity isn’t a destination; it’s a process.”
“I use the term ‘body respect’ to remind clients that we don’t have to love everything about the way our body looks to be able to care for it,” Jenkins says. “I use the terms ‘body acceptance’ and ‘body neutrality’ to help clients understand there can be a middle ground between body loathing and body love. I describe ‘body neutrality’ as simply allowing your body to exist without investing precious energy into loving or hating it. Ultimately, I believe body image occurs on a spectrum and can change from day to day; it can be very freeing to let go of the expectation that we have to always strive for love and positivity.”
Science Behind Body Positivity
Research on body positivity–related interventions generally comes in the form of interventions serving to increase positive body image. In the last decade or so, researchers and academics have moved beyond a focus on negative body image as a risk factor for poor physical and mental health. Increasingly, the focus has broadened to include how positive body image might promote better health.
Positive body image has two main components. One is body acceptance—accepting one’s body as it is, including its functionality and appearance—which includes caring for and respecting one’s body.4-6 The other is body image flexibility, which refers to the ability to openly experience thoughts and feelings about one’s body—even negative ones—without acting on them or trying to change one’s body to stop those thoughts and feelings.4,5,7
Body acceptance isn’t the same thing as body satisfaction, and, in fact, individuals can accept their bodies while at the same time being dissatisfied with them. Research suggests that, among women, body appreciation increases with age, even when body satisfaction does not.8
A 2019 study of 344 college students found that students who appreciated their bodies were more likely to engage in preventive health behaviors, such as eating a healthful diet and engaging in physical activity, but those who were only satisfied with their bodies didn’t have that increased likelihood. Previous research has found that college students who score high for body appreciation are less likely to diet or use weight loss pills, supplements, or shakes.9
Results of the Mayo Clinic’s FAITH! study published in 2021 found that Black women who had no or lower levels of body dissatisfaction had significantly higher intrinsic motivation and integrated regulation for healthful eating. The authors speculated that greater body image dissatisfaction may be mixed with internalized weight stigma, which can increase emotional eating, decrease dietary self-regulation and motivation, and increase the body’s stress response.10
Results of a study that drew from a random subset of individuals who enrolled in Noom, an app-based weight loss program, found that body appreciation and body image flexibility were higher after 16 weeks than they were at the time of enrollment. While there was a positive association between body appreciation and weight loss, there was no such association with body image flexibility. The authors say the results suggest that psychologically oriented weight management may be important to improve body positivity.11
Body Positivity in Practice
In light of the research, even body respect, appreciation, or neutrality may feel out of reach for many clients. If clients also are experiencing external weight stigma or struggling with cancer,12 a chronic disease, or mobility issues, this presents additional barriers to feeling anything positive about their bodies.
“Changing the internal narrative we have about bodies and weight is an important part of body image improvement,” Jenkins says. “We also can focus on behaviors that reflect body appreciation and body respect.” She says this can feel more challenging for patients with health issues, especially if they’ve been told that weight loss will not only make them feel better about themselves but it also will make them healthier. She emphasizes that self-care practices such as adequately and intuitively nourishing the body, engaging in joyful movement, getting adequate rest, setting boundaries around negative weight and body talk, and managing stress can improve physical and mental health—including increasing a positive body image and feelings of self-worth and improving blood sugar and cholesterol levels—even when weight doesn’t change.
Byrne says dietitians may need to take a team approach. “If someone’s body image struggles are negatively impacting their life, they should work with a therapist on processing past traumas and experiences and establishing healthier thought patterns and coping strategies moving forward. If someone has chronic health issues that strain their relationship with their body, a trusted physician can help manage symptoms. If clients seek out a dietitian for weight loss because their weight is limiting their mobility, the dietitian should consider referring them to a physical or occupational therapist who can help them improve mobility or perform daily tasks more easily in the body they’re in right now.”
Beale says talking with clients about practicing gratitude for their bodies—instead of looking at them with a critical eye—also can help, although it’s not easy. “Working to shut down the critical voice and focus on all the fantastic ways the body functions also are helpful. I’m still learning (and unlearning) a lot of what I thought was ‘healthful’ surrounding weight, and I’m a professional—so it’s no wonder this is complex for the general public.” Beale says learning about the social justice narratives surrounding weight and body acceptance is important and has forced her to recognize some of her own biases. “We have a long way to go as a profession and a society on the issue, but it’s certainly continuing to grow.”
— Carrie Dennett, MPH, RDN, is the nutrition columnist for The Seattle Times, owner of Nutrition By Carrie, and author of Healthy For Your Life: A Holistic Guide to Optimal Wellness.
References
1. Cwynar-Horta J. The commodification of the body positive movement on Instagram. Stream Int J Commun. 2016;8(2):36-56.
2. Muttarak R. Normalization of plus size and the danger of unseen overweight and obesity in England. Obesity (Silver Spring). 2018;26(7):1125-1129.
3. O'Hara L, Ahmed H, Elashie S. Evaluating the impact of a brief Health at Every Size®–informed health promotion activity on body positivity and internalized weight-based oppression. Body Image. 2021;37:225-237.
4. Tylka TL, Wood-Barcalow NL. The Body Appreciation Scale-2: item refinement and psychometric evaluation. Body Image. 2015;12:53-67.
5. Tylka TL, Piran N. Handbook of Positive Body Image and Embodiment: Constructs, Protective Factors and Interventions. Oxford, England: Oxford University Press; 2019.
6. Linardon J, McClure Z, Tylka TL, Fuller-Tyszkiewicz M. Body appreciation and its psychological correlates: a systematic review and meta-analysis. Body Image. 2022;42:287-296.
7. Linardon J, Anderson C, Messer M, Rodgers RF, Fuller-Tyszkiewicz M. Body image flexibility and its correlates: a meta-analysis. Body Image. 2021;37:188-203.
8. Tiggemann M, McCourt A. Body appreciation in adult women: relationships with age and body satisfaction. Body Image. 2013;10(4):624-627.
9. Thomas EV, Warren-Findlow J. Body image, self-esteem, and behavioral risk for chronic disease among college students: additional evidence for integrated prevention. J Am Coll Health. 2020;68(6):658-665.
10. Manjunath C, Jenkins SM, Phelan S, et al. Association of body image dissatisfaction, behavioral responses for healthy eating, and cardiovascular health in African-American women with overweight or obesity: a preliminary study. Am J Prev Cardiol. 2021;8:100254.
11. McCallum M, Ho AS, May CN, Behr H, Mitchell ES, Michealides A. Body positivity and self-compassion on a publicly available behavior change weight management program. Int J Environ Res Public Health. 2021;18(24):13358.
12. Brederecke J, Heise A, Zimmermann T. Body image in patients with different types of cancer. PLoS One. 2021;16(11):e0260602.