This summer (2016) I read the novel Dietland by Sarai Walker. It’s rare to find a novel that is both relevant and sensitive to the concerns of my patients, rarer still one that features a main character in a large body whose happiness is not predicated upon successfully losing weight. I found the book so empowering, I’ve been recommending it to patients.
The book tells the story of Plum Kettle, a young 300-pound woman who lives in New York and works as a ghost-writer answering angsty emails to the editor of a teen magazine. She has been on multiple diets and is planning to have weight loss surgery. While living in the crowded city, she tries hard to not be noticed. Rather than living in the present, she focuses on planning for her future life as a thin person. She orders clothing online that will fit her future thin body.
Walker vividly portrays the stigma and unjust treatment faced by people who inhabit larger bodies. Like many of my larger patients with histories of repeated dieting, Plum suffers from depression and oppression related to being in a larger body. Living in a larger body in a world consumed by diet culture means not physically conforming in certain situations (think restaurant booths, waiting room chairs, and airplanes) and leads to shame and fear of being persecuted in social situations due to one’s size. Not surprisingly, people in larger bodies often have histories of dieting to try to make their bodies conform to the thin cultural ideal. However, because dieting doesn’t work and weight suppression ultimately drives eating disorders and weight regain, people in larger bodies often experience weight regain binge eating, and anxiety and depression.
Out of fear of being teased about her weight, Plum avoids parties, clubs, bars, beaches, amusement parks, and airplanes and, painfully, spends most of her time alone, answering emails either from the café or at home in her apartment.
Through a series of unconventional events, over the course of the book, Plum gains the strength to resist the unrealistic cultural archetype. She turns her anger outward, confronts weight stigma, and stands up to the pressure of society. Ultimately Plum finds her voice and becomes empowered. She learns to accept a body that does not fit the thin ideal, stops putting her life on hold, and starts living her life as she is:
It felt good to be free. With unexpected power in my legs, I kept going, racing ahead with the wind and the sun on my face, taking a leap into the wide world, which now seemed too small to contain me.
While the treatment I offer to patients is more traditional than Plum’s journey in the novel, I hope my patients will undergo the same transformations. In my work with all patients of every size, I employ CBT for eating disorders, but I supplement this evidence-based treatment with a weight-neutral approach and education about the impact of diet culture and weight stigma. I help clients to cultivate a more accepting and compassionate relationship to their bodies and to turn their anger outward, holding up a new lens through which to see the world. I seek to empower them to advocate for their needs while challenging diet culture. This transformation is profound and exciting to witness.
My favorite passage in the book is a line of questions I want to ask my clients:
“I want you to consider something, hon. What if it’s not possible for you to ever become thin? What if there is no one day? What if this is your real life right now? What if you’re already living it?”
The book is both fun and inspiring.
Addendum: June 2018: And, it is being turned into a television show which premieres on AMC on Monday, June 4th, and stars Joy Nash as Plum Kettle. Appropriately, the tagline is “Join the Revolution!” I hope you’ll join me and tune in. I was fortunate to attend an event with Marti Noxon, the producer to discuss some of the important issues that will be highlighted by the show, including weight stigma.