Medical Diets Have Gone Mainstream for All the Wrong Reasons
Weight loss was never the purpose of Ketogenic, FODMAP, or gluten-free diets.
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Like many people, I was extremely stressed when the COVID-19 pandemic hit in March 2020, especially as someone who has an autoimmune disease. My anxiety manifested itself in physical ways, and I started to become sick after I ate anything. After I saw a gastroenterologist, he recommended that I try the low FODMAP diet, which cuts out food and drinks with fermentable oligosaccharides, disaccharides, monosaccharides, and polyol, to figure out what types of food were making me sick. Due to not eating enough, I was very, very tired and light-headed.
It turns out dairy was the culprit, and after going on this diet for a few weeks, I was able to gain the weight back because I was not drinking and eating things that were making me sick. My medical diet helped me get healthier. Getting off the low FODMAP diet was easy for me emotionally because I hated how restrictive it was. This was also the first diet I had ever been on, at the age of 22. This diet is supposed to only be temporary, even under medical supervision. After a period of getting off of all FODMAP foods, people try different types of them—one by one—to see what they are negatively reacting to. Then, the diet is done. I am still off of dairy.
But, when I went on blogs to learn more about the low FODMAP diet, as my doctor advised, I saw people recommend this diet for weight loss. This confused me at the time, as this diet was created to sort out intolerance issues for people with irritable bowel syndrome and similar conditions. Due to potential malnutrition with unsupervised low FODMAP diets, people without the need to be on it may feel as weak as I did before going on it.
Celebrities, influencers, and people in our lives talk about going on medical diets like Keto, gluten-free, and full-liquid diets to lose weight. But weight loss was never the goal of these medical diets. Weight loss also is not a sign that someone is healthier. In fact, it can be the opposite for some people. The mainstreaming of these diets not only promotes diet culture but can put people’s lives in danger by promoting disordered eating, leading to malnourishment and other potential health issues.
Low FODMAP was created for people with irritable bowel syndrome and/or those that have small intestinal bacterial overgrowth. The Ketogenic diet was created to help manage seizures in children who haven’t responded to other treatments. Gluten-free was created for people with celiac disease, who by nature of this health condition have a gluten intolerance. Weight loss is not a treatment for any of these health conditions, and diets made to manage them were not created with weight loss in mind, either.
A major red flag with the mainstreaming of medical diets is if someone goes on one without being monitored by a doctor and/or a dietician. Like most medical treatments, supervision is needed for medical diets. “The high risk of malnourishment from diets like Keto and FODMAP is why they are intended for only short use with medical monitoring,” said Tholia Davila, a registered dietitian based in California.
Medical diets can be helpful for people who have conditions that may benefit from them. However, any sort of restrictive eating may be complicated for people who have a history of disordered eating or are at risk of developing disordered eating, according to the American College of Gastroenterology.
The Relationship Between Celebrity and Diet Culture
In 1988, Oprah Winfrey bragged on her show that she lost a significant amount of weight to her fans while on a liquid-protein diet. To the New York Times’s credit, when it had reported on this at the time, the paper did include the fact that “at least 60 deaths were attributed to early formulas that had nutritional inadequacies.” People on a full liquid diet often do not have enough fiber, vitamins, and minerals, according to MedlinePlus.
Oprah is just one of many celebrities, and now influencers, that promote aspirational lifestyles and ideal bodies. But restrictive diets are nothing to aspire to, and there’s something inappropriate with portraying weight loss as an accomplishment. How a celebrity looks in a photograph after going on a medical diet to lose weight also tells fans nothing about their energy levels, potential anemia, and potential gastrointestinal problems.
There have been some celebrities that have spoken out about the negative effects of trying medical diets for weight loss purposes. In 2018, Dancing with the Stars professional dancer Witney Carson told Women’s Health that, “I did lose weight on it, but my skin broke out” while on the Keto diet. She then had to manage her eczema, as this diet triggered an immune response in her.
And it’s not just strictly medical diets that can be bad for our health, other fad diets can be, too. Kim Kardashian revealed after she changed her diet to lose weight before the Met Gala, she had a psoriatic arthritis flare so bad that she “couldn’t really move [her] hands.”
It’s also important to remember whenever celebrities talk about their weight, health, and/or diet, they’re not actually “just like us.”
“Often, there are paid partnerships or money behind these endorsements, and a mix of genetics, photoshopping, cosmetic surgeries, private chefs, and personal trainers, alongside the pressure of being in the public eye, are parts of celebrities’ food and exercise routines,” said Brenna O’Malley, a registered dietician who runs Wellful.
According to the National Eating Disorders Association, weight stigma and ideal appearance internalization are two risk factors for developing eating disorders. Every time the media and celebrities talk about how certain diets gave them their “best look,” this could be sending the wrong message to the public.
Changing How We View Food
When there are articles on the latest medical diet that has been mainstreamed, there is often no mention of how going on these diets can impact people with eating disorders or anyone else who may struggle with disordered eating.
“For people who might be predisposed to an eating disorder, starting these diets turns on the switch to having a full-blown eating disorder,” Davila said. “And eating disorders are deadly, they are the deadliest mental illness, and they are an overlooked epidemic in the U.S.”
And an epidemic where BIPOC people are overlooked. People of color with eating disorders are also less likely to be asked about eating disorder symptoms and are half as likely to be diagnosed or to receive treatment than their white peers, according to the National Association of Anorexia Nervosa and Associated Disorders.
With the risks that eating disorders pose, why is diet culture promoted? The truth is, diet culture sells, and companies that sell cookbooks and other items promoting medical diets to the masses likely know this. Or they may not know enough about medical diets, which is also a problem.
“[Diet culture] overemphasizes the pressure on bodies to be continually in pursuit of being smaller, appear younger, and fit arbitrary and always changing standards of beauty and fitness that creates a hierarchy of people and bodies,” O’Malley said.
Just like working out, eating foods that make you physically feel good is not necessarily a bad thing. For example, making sure you have enough protein is good for you. Punishing yourself to look a certain way by starving yourself is a problem, and can have consequences physical and mental side effects.
Diets can be helpful for some, but diet culture is bad, and should perhaps be flung into the sun. Medical diets work when they help people feel better, like I did after being on the low FODMAP diet, not looking a certain way.
O’Malley recommends that an effective way to do this is to view food in a neutral way. If you have an intolerance to food or a food group is one thing, but we shouldn’t inherently view foods as “good” or “evil.”
“If we viewed food as morally neutral, and didn’t see certain eating patterns or restrictions as ‘better’ or ‘enviable’ then we would likely not feel the pressure to jump on any diet we see someone else on, and would better be able to find ways of eating that support and feel good to our individual bodies and selves,” O’Malley said.
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