But in a sense, it has always been like this, and it is like this everywhere. Every culture has an “aspirational beauty ideal” that women are encouraged to strive for. Our own grandmother told us stories from the 1930s, when her family was so poor they lived in a house their father had built from scraps; they were lucky to have a toilet, but it was plumbed into the middle of the house, with no privacy. She and her sisters were thin; in fact, they had grown up on the edge of starvation. Still, in high school the three girls scraped together money to buy “diet aids,” which were supposed to last them a month. The “aids” turned out to be candy (because sugar was supposed to be an appetite suppressant) and they ate the whole box in one afternoon.
And it isn’t just white people or Western culture. Taiwanese American Lynn Chen, founder of thickdumplingskin.com, describes explicit expectations from her Taiwanese parents “to eat large quantities of food but remain skinny,” which shaped her problematic relationship with food and her body.5
And it doesn’t have to be thinness. The Jamaican “ideal woman” has lots of curves, and girls have been known to take “chicken pills”—medication to fatten poultry—in order to obtain those curves. But the pills contain arsenic.6
Everywhere, there is a beauty ideal, and always, there are those willing to risk their health to attain it. Far from hearing the distress signals our body is sending, its desperate cries for food, sleep, being held, and, in Julie’s case, bowel movements, we relate to our bodies only in terms of its appearance.
But imagine what it would be like to live in a culture where that feeling we had on the day we were born stayed the same all through our childhood and into adolescence, a culture that didn’t constantly reinforce the idea that a girl’s or woman’s body is supposed to be one specific shape and size, and if it’s not she must, at all costs, try to make it that shape and size. What if the shape we grew into was just accepted as the natural shape of our bodies, as lovable each new day as it was on the day we were born? What if the body we aged into—those of us lucky enough to grow old—was as beautiful in our own eyes, when we looked in the mirror, as worthy of love and protection, as the body we had on the day we were born? What if the shape of our bodies was peripheral to our relationship with our bodies, and we could pay compassionate attention to our body’s needs without assessing whether it “deserves” food or love?
What if?
This is the chapter where we teach you how to love your body.
The Bikini Industrial Complex
This is our name for the hundred-billion-dollar cluster of businesses that profit by setting an unachievable “aspirational ideal” for us, convincing us that we both can and should—indeed we must—conform with the ideal, and then selling us ineffective but plausible strategies for achieving that ideal.7 It’s like old cat pee in the carpet, powerful and pervasive and it makes you uncomfortable every day—but it’s invisible and no one can remember a time when it didn’t smell. Let’s spend a few paragraphs shining a black light on it, so you can know where the smell is coming from.
You already know that everything in the media is there to sell you thinness—the shellacked abs in advertisements for exercise equipment, the ONE WEIRD TRICK TO LOSE BELLY FAT clickbait when all you wanted was a weather forecast, and princesses played by “flawless” thin women on TV. The Bikini Industrial Complex, or BIC, has successfully created a culture of immense pressure to conform to an ideal that is literally unobtainable by almost everyone and yet is framed not just as the most beautiful, but the healthiest and most virtuous.
But it’s not just magazine covers and other fictions that get it wrong. Even your high school health class had it wrong. Your doctor had it wrong, because her medical textbooks had it wrong, because the federal government had it wrong. Like “Big Oil” and “Big Tobacco,” “Big Bikini” has lobbied government agencies to make sure their products have the support of Congress. The body mass index (BMI) chart and its labels—underweight, overweight, obese, etc.—were created by a panel of nine individuals, seven of whom were “employed by weight-loss clinics and thus have an economic interest in encouraging use of their facilities.”8
You’ve been lied to about the relationship between weight and health so that you will perpetually try to change your weight.
But listen: It can be healthier to be seventy or more pounds over your medically defined “healthy weight” than just five pounds under it. A 2016 meta-analysis published in The Lancet examined 189 studies, encompassing nearly four million people who never smoked and had no diagnosed medical issues. It found that people labeled “obese” by the Centers for Disease Control and Prevention (CDC) have lower health risk than those the CDC categorized as “underweight.” The study also found that being “overweight” according to the CDC is lower risk than being at the low end of the “healthy” range, as defined by the U.S. federal government and the World Health Organization (WHO). 9
Another meta-analysis even found that people in the BMI category labeled “overweight” may live longer than people in any other category, and the highest predictable mortality rate might be among those labeled “underweight.”10
“What?” you ask, in disbelief.
“Exactly!” we respond.
“What?” you ask again.
“I know!” we reply. “It’s bananas!”
Even research that describes itself as contradicting these meta-analyses and confirming that “overweight” is bad concedes, “We do not yet have convincing data from randomized controlled trials in humans that methods used for promoting weight loss among obese persons prolong life [emphasis original].”11 Translation: Even if you lose weight by buying whatever advice they’re selling (and there’s no scientific reason to believe you will), don’t expect to live longer. Taking it even further, the newest research is suggesting doctors warn middle-aged and older patients against losing weight, because the increasingly well-established dangers of fluctuations in weight outweigh any risk associated with a high but stable weight.12
And yet weight stigma is so deeply entrenched that even the researchers who study health and weight are prone to “scientific weightism,” the empirically unsound assumption that thin is good and fat is bad.13 It leads physicians and scientists to write sentences like “It is well established that weight loss, by any method, is beneficial for individuals with diabetes.”14
“By any method”? Tuberculosis? Radiation therapy? Internment camp? Amputation? Come on.
Weight and health. Not the same thing.
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Part of the nonlinear relationship between BMI and health is due to the fact that people vary naturally in their body shape and size—just look at photographer Howard Schatz’s 2002 book Athlete, illustrating the vast and beautiful range of body shapes and sizes of Olympic athletes.15 Every one of those people, from the tiniest gymnast to the biggest weight lifter, is at the absolute peak of their sport. Health comes in every shape and size; some people are healthiest at a lower BMI and some are healthiest at a higher BMI.
But part of this is because the BMI is nonsense as a measure of personal health. It’s literally just a ratio of height to weight, which is why a doctor told one of Emily’s students—an internationally competitive figure skater, i.e., a professional athlete—that she was “overweight,” even though she was so low-body-fat that she was skipping periods. She had so much muscle and such dense bones that she weighed as much as a man her height. And again, even studies that assume body fat is dangerous agree that BMI misclassifies as “healthy” half of people who are “normal or just overweight,” but who are nevertheless at risk for all the health issues associated with obesity.16 People of any size can be healthy or sick; you can’t tell by looking at them.
Does the BMI chart mention that this codification of “health” relies more on bias than on science?17 Nope. It just labels people as “unhealthy,” ignores the science, and gives physicians and insurance companies government sanctioning to collect fees for treatment of this “disease.”18
And we all believe it, because our culture has primed us to judge fat people as lazy and selfish.