I Designed Programs To Help People Lose Weight. Everything I Thought I Knew Was Wrong.
Content note: I use the term “obesity” in the title and throughout the piece only for the purpose of describing my career focus before I realized my research was causing harm. This term may seem like neutral medical terminology, but for many, it is stigmatizing.
I was an “obesity” researcher for nearly two decades, and in that time, I helped design and test numerous weight-loss programs. Like other travelers along my career path, I had good intentions from the start. I genuinely believed I was helping people by supporting them to lose weight. But I was wrong.
I struggled with my own weight and body image ever since I was a young child. Growing up just outside New York City in the ’80s and ’90s, a time when diet culture was alive and thriving, I developed core beliefs that something was wrong with my body and that being fat was something to avoid — at all costs.
In my early teens, I attended weight-loss camps with the hope that if I could just shrink my body, things would be better. I lost weight, but it quickly returned. I blamed myself, thinking that if I really wanted to lose weight, I would have to do better. By the time I was 15, I decided to become a dietitian.
I thought more knowledge about nutrition was the key to controlling my own weight and that I could help others along the way. This choice ultimately morphed into a career in research, where I focused on investigating how to “solve” chronic disease with weight loss. But even in my tightly controlled studies, with ample resources and daily support, most of the participants achieved minimal weight loss and gained the weight back once the study ended.
After many attempts to design an effective weight-loss program, I realized that the data from the studies I worked on never succeeded in showing that weight could be modified long-term. And it wasn’t just in my own research — the broader scientific literature showed similar results. In one prominent national study, only 10-20% of study participants maintained weight loss after 1 year, with even lower rates years later.
I also realized that identifying weight as the primary indicator of health was problematic. It is impossible to tell someone’s health just by looking at their body size, and being thinner does not necessarily equate to being healthier. The reality is that much of our weight and shape is determined by genetics — just like height. The misguided belief that we can all be in small bodies is not only wrong, it’s harmful and discriminatory.
After much internal reflection, I realized I had an eating disorder, stemming all the way back to my childhood. I also realized that my eating disorder was what drove many of my career decisions and beliefs about weight and health.
After receiving treatment in my late 30s, I saw my career studying “obesity” in a new light: My work was perpetuating harmful practices and stereotypes, and I couldn’t be a part of that anymore. I switched my focus to researching eating disorders, how they present themselves and impact diverse people, and what we can do to treat them more effectively.
Along this journey, I learned a few key things I think are important for organizations, physicians, researchers and the general population to understand.
There are no “good foods” or “bad foods.”
The myth that some foods (e.g., cookies) are “bad” and are to be avoided in favor of “good” foods (e.g., fruits and vegetables) is one of the harmful beliefs that led to my eating disorder in the first place. Dieting or restricting any foods is often a gateway to disordered eating. People need all kinds of foods to live and thrive – even the sugars and fats we’ve been falsely taught to always turn down.
Moreover, this black-and-white thinking ignores the fact that not all people can access the so-called “good” foods. Social determinants such as poverty and food insecurity make it challenging for many to access or afford fresh fruit and vegetables, find time to prepare “balanced” meals three times a day, or even know when their next meal will be. Food insecurity is highly correlated with eating disorders, and the message that some foods are to be avoided to better your health only perpetuates that risk.
Weight is not intrinsically tied to health.
The health care industry has put too large an emphasis on the relationship between weight and health. Rather than investigating other factors for conditions like chronic pain or diabetes, many clinicians will almost instinctively turn first to weight and suggest that weight loss is the answer. This type of weight bias has increased over the past several decades.
Weight bias disproportionately harms people in large bodies, who often avoid seeking health care because of the stigma they experience. Clinicians must prioritize eliminating other, more serious, root causes of symptoms first, instead of centering weight as the primary factor — no matter who they’re treating. They also need to listen to their patients and trust that they know their bodies best instead of refusing to investigate an illness or pain based on the patient’s body size.
It’s never too late to unlearn harmful ideas.
I held my beliefs about weight, food and health for decades — both personally and professionally. It’s easy to think that once you hold a core idea for so long, and even build a career out of it, it can be impossible to change your perspective.
What helped me unlearn these beliefs was the recognition that I was encouraging harmful behaviors that often show up in people with eating disorders. The only difference is that we think these behaviors are helpful for those in large bodies and harmful for those in thin bodies. The truth is, these behaviors are harmful for everyone.
My journey hasn’t been an easy one, but I have gained so much as a result. I gained weight, as my body needed more nourishment. I gained freedom from the oppressive beliefs that my worth is tied to my weight. I gained a new passion for researching eating disorders and using what I learn to help others.
I also gained better mental health, greater connection with my family and friends, and a firm belief that we must dismantle our culture’s harmful ideas about weight and health so our next generation of children can grow up believing their bodies don’t need to be changed in order for them to have value.
Dr. Dori Steinberg is a researcher, registered dietitian and advocate for eating disorder prevention. She is currently VP of Research and Policy at Equip Health.