Reclaiming exercise from diet culture
Exercise is for everyone. It doesn't need to make you smaller.
Welcome to Chief Complaint! I’m so happy you’re here. 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. Thanks for joining me.
One of my biggest challenges as a size-inclusive doctor is talking about exercise.
In my clinical world, I don’t talk about weight. I don’t tell my patients to lose it. In fact, many of my patients routinely decline to be weighed. (Which I am 100% cool with.) Slowly but surely, we’re centering our conversations in the exam room on more meaningful measures of wellness and health.
But what are those meaningful measures? Number one, in my mind, is regular exercise.
There’s boundless evidence about why exercise is good for you. It protects your heart and your lungs. It can help treat anxiety and depression. It saves your joints. It can prevent diabetes from progressing.
And most importantly, you do not need to lose weight for exercise to be good for you. In fact, exercise alone isn’t particularly effective for losing weight, and yet people of all sizes who regularly move their bodies reap the benefits. (Here’s an interesting scientific paper about this phenomenon, although warning, the author does use lots of stigmatizing language.)
(I also note that not everyone is able to exercise, or wants to exercise, and that’s totally okay. This is especially true for people in recovery from disordered eating and compulsive exercise. Your body is yours, and exercise is not an ethical obligation.
However, I am a primary care doctor. Most of my patients come to see me for support with their overall health, and they ask me for my advice. My advice is that exercise, in whatever form it takes, is almost always going to make you feel better. You are free to ignore this advice if it doesn’t feel right for you.)
But when I say “exercise,” so many of my patients hear, “You should really lose some weight.”
I can’t tell you how often this happens. It’s usually in the context of another issue a patient is experiencing — say, joint pain — and I gently suggest, “Getting outside for a walk each day might really help your knee pain.”
“Ugh. I’ve gained so much weight recently,” my patient replies. “I’m so bad.”
I haven’t touched on weight at all, and yet the mere mention of walking triggers a cascade of associations about body size and the “virtue” of being thin. It’s so challenging to steer the conversation back to a place of weight-neutrality, and I often struggle to do so.
Diet culture has such a claim on exercise, and I want to take it back.
So what can we do? Here are a few ideas I’ve been thinking about, and I’d love to hear yours.
Call it “movement.” Many activists and writers in the body acceptance community have turned to the term “movement” as an alternative to “exercise.” I love this word, and I appreciate what activists are trying to do with it. Exercise is loaded with baggage: it conjures images of sweating away at the gym, logging punishing hours on the treadmill to atone for the sin of too many chips. Exercise is Puritan and tinged with morality. Movement, on the other hand, feels freeing, relaxed, almost … fun.
In my clinical world, however, where the vast majority of my patients aren’t a part of fat activist spaces, most people have no clue what I mean when I say “movement.” Believe me, I’ve tried it, and it just results in puzzled looks. So in clinic, I stick to the term “exercise,” for better or worse.
Create body inclusive places to work out. I have a friend who belongs to a gym only for women and non-binary people — how cool is that? The same concept applies to size-inclusive exercise spaces, both online and IRL. There was a yoga studio in my old neighborhood in Philadelphia that advertised size-inclusivity in huge letters on its storefront. And online, the options are endless. The amazing
has published a huge, crowdsourced guide to fat-friendly workouts. It’s worth checking out.Remove the weight loss language. I’ve loved spinning for years, since a friend from my freshman dorm first dragged me to the intimidating, blacklight-lit, bass-pumping classes in our college gym. In those days, the instructors talked openly about weight loss as a goal. “Pump up the resistance, ladies!” they would yell. “It’s almost bikini season!”
In the twenty years since then, I’ve seen a huge change — for the better. Group classes and fitness content online has largely shifted the language away from “get skinny” to “get strong,” and I’m here for it. These days, I’m a Peloton gal. (Love it or hate it, but it works for my busy mom-doctor life.) And while there’s still a major issue of size-diversity amongst Peloton instructors, at least they’ve dropped the weight loss chatter. I fully admit I have not done a scientific analysis of online fitness content — God help whoever has signed up for that project for their PhD dissertation — so I know there’s plenty of diet culture out there. But overall, I’ve noticed a positive shift in the discourse towards more holistic fitness goals.
Aim for goals other than shrinking ourselves. When I was pregnant and had terrible insomnia, I had a sudden realization that exercise might help me sleep. I was pregnant during as that first pandemic winter, and I was holed up inside, doomscrolling pregnancy subreddits. (Yes, even doctors do this, I’m sorry to say!) I knew I was supposed to be working out, but I was too anxious and physically uncomfortable to return to my old routines. Then, I had an epiphany: maybe going for a walk each day would allow me to sleep better. Although it sounds obvious now, it was a radical reorientation for me. My whole life, I had been thinking of “exercise as a tool for weight loss.” But suddenly, as a pregnant person, I wasn’t supposed to lose weight. It was freeing, to start to think of my daily walks as something that might make me feel good.
I’ve also found that exercise in and of itself is a great tool for letting go of body shame. When I’m sweaty and exhausted, the last thing on my mind is how my body looks in shorts. Exercise helps me feel embodied in a really positive way — it helps me focus on how my body feels and moves, and think of myself less through the gaze of others.
This is me on a hiking vacation this past spring in southern Utah, thinking about snacks, or sunscreen, or how to motivate my toddler to make it to the end of the trail, or the meaning of life. I definitely was not thinking about how my booty looked.
I think also regular exercise can reframe our relationship to food. When we’re moving our bodies, food becomes a source of nourishment and happiness, and loses some of its diet culture baggage. A popsicle after a long bike ride just tastes so good. Eggs benedict at brunch with friends after a yoga class is perfection.
This concept was so beautifully addressed in this Longreads piece by Krista Diamond about food and hiking:
When you’re hiking, you eat what you’ve brought with you, what you can get. Eating, even eating junk food—sometimes especially eating junk food—is not just a good idea but potentially the difference between life and death, or at the very least the difference between an enjoyable experience and a grueling one. No one has ever opened up a packet of Oreos on a mountaintop and said, “I’m being so bad.”
Amen.
What do you think? Are conversations about exercise helpful, or harmful? How can we disentangle an exercise practice from diet culture and pressure to lose weight?
I'm a nurse (in school for FNP!) in cardiac rehab, so we talk about exercise a lot. I've found that the guidelines of 150 minutes of MODERATE exercise has really helped me in my own relationship with exercise. Prior to having children, I was an ultramarathoner, so moderation was not really in my vocabulary. Now I'm understanding so much more that a 2 mile brisk walk is just as good (better?) for my health as a 15 mile trail run. For my patients, I try to steer the conversation away from weight and strict nutrition specifics. We have to weigh patients because of the concern for heart failure fluid retention, but we remind everyone of the reason for it and that we don't care about the number itself. And luckily our nutrition staff has moved us away from any weight-related goals for patients.
I hate, hate, hate, exercise. The trauma of elementary and high school gym class lasts forever. I have holes in the bones of my knees and ankles (Avascular necrosis from IV prednisone). The emotional and physical pain from exercise drains me. I'm 61. At 224 I was declared too fat to live - no kidney transplant listing for me unless I lost weight and "got stronger." I passed every test they threw at me, but that isn't good enough. So I go to the YMCA 5 nights a week, most weeks, for the past 4 years. I need to PROVE I'm worthy of life. My endo is the only medico who openly tells me exercise will NOT lead to weight loss. All the rest are convinced that the myth of calories in, calories out will make me thin. It's all BS. I was able to get down to 170 when Mourjaro let me stop insulin. My CKD is from 30+ years of colon free living. I have so many restrictions. I'm not supposed to lift or carry more than 5 pounds. So weight work is out. Walking brings tears to my eyes after 15 minutes. Any cardio leads to severe pain in my knees and an asthma attack. I slowly ride the recumbent bike and recumbent stepper for 1-4 hours a night. When I've tried to go all out my asthma kicks in. I work all day, ride at the Y all night, and fall into bed when I get home after the Y closes at 9. I listen to audiobooks and catch up on emails and news. I still hate it. I've tried to do some of the leg weight machines, but am unable to adjust the seats and weights properly. I've paid hundreds for personal training consultations and they have been useless. I can't find anyone who knows what to suggest to someone with a 5 pound weight limit. My medicos all think I'm lying about eating once a day and going to the y nightly. They've been brainwashed into thinking that's the road to skinny town. As a 61 year old, postmenopausal, diabetic, life long fat person no amount of calorie restriction and exercise will ever make me skinny. I've plateaued at 170, my high school weight. Most kidney transplant programs still won't take me after losing 50 pounds. Sorry, I'm so crabby. I'm so sick of being sick. AND sick of Dr. who blame my weight for everything.