How to diffuse holiday diet talk
And not end any relationships in the process
Welcome to Chief Complaint! For those of you who are new, this newsletter features intermittent musings about medicine, gender, parenting, and body liberation — all from your friendly neighborhood primary care doc. I’m so happy you’re here.
A few reminders:
I will be talking with the Columbia University Narrative Medicine program on Tuesday 12/3 at 7 pm EST on Zoom about my career as a physician and a writer. If you’re interested in how we tell stories about illness and wellness, please register here.
The Association for Weight and Size Inclusive Medicine will be having its kickoff event on Wednesday 12/4 at 8 pm EST on Zoom. We’d love to have you join! Please register here. (It’s $35.) It’s aimed at health care providers, but all are welcome.
It’s Thanksgiving! What are you cooking and eating this week?
I made a vegetarian stuffing over the weekend for a Friendsgiving (such a delicious food — why oh why do I make this only once a year?) and my husband and I will be tag-teaming some veggie sides and a TBD pie for the two Thanksgivings we’re going to in the coming week, one for each side of the family.
(I’d like to brag, for a moment: In 2022, I won an unspoken [and yet still highly competitive] pie contest with one serious foodie branch of the family where my coconut cream pie was eaten first out of a whopping twenty pies. For 16 people. So maybe I should make coconut cream pie again this year?)
Thanksgiving is such a great holiday — focused on food and eating, not acquiring plastic crap for my kid that we can’t wait to dump on Buy Nothing as soon as he loses interest. Still, the holiday comes with challenges for a size-inclusive doc like me, trying to fight the good fight against fatphobia and policing of bodies. Even my Thanksgiving tables — full of loving relatives who support bodily autonomy when it comes to topics like reproductive health and the rights of transgender kids — are not free from diet culture.
What’s a body liberationist to do? I’ve seen lots of suggestions online about how to handle holiday body talk, and there’s good advice out there. Yet a lot of this advice seems more confrontational than I prefer. I understand that some people really do need to “set clear boundaries” and cut off discussions with relatives who make them feel unsafe. I respect that.
But what about people — like me, and I suspect many of you — who want to nourish relationships with friends and family who aren’t quite as radicalized? How can we talk with relatives who don’t yet see the connection between the surveillance of body size and all those other “more serious” issues of bodily autonomy?
Here are a few ideas.
Remember that undoing diet culture is hard work... At work the other day, I found myself chatting with a colleague who had brought in a huge box of pastries from a local bakery chain to share with the office. I made a joke that it was “dangerous” that there was an outpost of the bakery close to my home. Me! Doctor anti-diet! It was a reminder how deeply ingrained the culture of fatphobia and weight loss is. A reminder to be gentle with ourselves if we make mistakes.
…But remember that undoing diet culture is also important work. Last week, our medical school’s chapter of Medical Students for Size Inclusivity hosted a talk with a psychologist from the Children’s Hospital of Philadelphia who works with hospitalized patients experiencing medical instability related to eating disorders. She cares for very, very sick teenagers — kids with unstable vital signs because they’re malnourished. In the Q&A with our medical students, a theme emerged: often, her patients’ disordered eating worsened with a physician’s suggestion to lose weight, or a physician’s suggestion to restrict the type of foods the patients could eat (often due to a medical condition). Thankfully, most kids don’t go on to develop severe disordered eating after these kinds of offhand comments, but it’s a reminder at how pervasive — and how deeply harmful — diet talk can be.
Use humor. Our guest speaker had a great suggestion for how to respond to these kinds of comments: “It tastes so much better when we all have to feel guilty about it!” It’s good advice for diffusing the kind of low-key fatphobia that permeates every big meal.
Set rules beforehand. A message to the family group text — “I’d love to avoid talking about body size and food guilt this year” — can be a lot easier than responding to a hurtful comment in the moment.
Offer the benefit of the doubt. Many of the people in my life who can’t stop talking about clothing sizes see these discussions as a way to bond with others, particularly women they may find it otherwise hard to talk to. It’s a regression to the lowest common denominator when confronted with the daunting task of making chit-chat with distant in-laws at the holiday meal, or with co-workers at the office potluck. Remembering this helps me redirect the conversation to other topics — the election, anyone? — and helps stop me from privately spiraling.
Redirect. That brings me to my next suggestion: Come prepared with a list of other conversation topics. My medical students have gotten me into doing ice-breakers before class, and they’ve taught me some doozies. “What color represents your personality?” “What position do you sleep in?” “When you were a kid, what did you want to be when you grew up?” Way better than discussing whether or not your sister-in-law can fit into a particular dress before her kid’s upcoming Sweet 16.
Use kids as an excuse. Sometimes, it can feel a lot easier to challenge hurtful or discriminatory behavior when I’m acting like a mama bear. “Do you mind if we don’t talk about weight loss in front of the kids?” is a straightforward response that offloads some of the confrontation towards a shared goal of protecting the children at the meal. And yes, they’re listening.
I hope these suggestions help! And I’d love to hear from you: how do you deal with diet talk during the holidays?
Happy cooking and eating, everyone.
Thank you for sharing these suggestions. Having had loved ones with eating disorders, this is a topic near and dear to me (plus, I'm going to be sharing a similar piece of my own tomorrow). I'm always looking for new ideas for how to deflect diet talk. The humor approach is one I would like to try, but I'm often just not fast enough on my feet. While I don't always address diet talk (not engaging often is enough to derail it), I've also used the phrase "we don't talk about bodies" multiple times. Though confrontational, it's quite effective at killing diet talk.
Hi Mara,
Thanks for the great suggestions. I'll share one quick anecdote from my psychotherapy practice:
I have a 40-something male client who's struggled with bulimia since his teen years. In the last 5 or so years, he's been able to significantly cut back the purging behavior and has come to enjoy how his body looks. In the process of normalizing his relationship with food, he gained some weight but was liking how it felt and looked—until his PCP mentioned the weight gain and suggested he lose 20 pounds.
Of course he went spiraling back into the bulimia.
I've had my own experiences with fatphobia from healthcare professionals. As you pointed out, we need to be very careful how we talk to and about our patients. We can cause real harm if we're not mindful of our own biases.