Does Dieting Increase the Risk of Chronic Pain?

Recently I sat down with Cara D’Anello of Happy Valley Nutrition to talk about my journey from yo-yo dieting and weight cycling to intuitive eating and how that experience has informed my relationship with chronic pain. Over the past several months I have been forming a hypothesis that a person who has struggled with a disordered relationship with food is more likely to develop persistent pain later in life. My evidence has not only been from my own lived experience, but also from what I have learned from my clients.

Here’s three of the patterns I have observed that have led me to this conclusion:

1. Disconnect from physical sensations

Anyone who has sustained calorie restriction over multiple months knows that it cannot be done without learning to override hunger signals. As your stomach growls you learn “tricks” to make it feel full without adding much in the way of calories: drinking hot tea, eating unflavored popcorn, bloating yourself with carbonated soda water. Most people end up obsessing over thoughts of food (it turns out we cannot override thousands of years of the human will to survive with a 6-month diet) until they break down and drown themselves in guilt and nachos. Wracked with the weight of shame, they start all over the next day. It’s a losing battle against biology, which is why diets don’t work.

Even if you manage to free yourself from the grip of diet culture, the time spent pursuing a smaller body will likely have resulted in complete neglect of your physical sensations for so long that it becomes a conditioned behavior. Many people with long term dysregulated relationships with food will have completely compartmentalized their emotional selves from their physical selves, such that they are virtually numb. 

As Bessel van der Kolk writes in The Body Keeps the Score (a book about the physical ramifications of trauma):

“About three quarters of patients with anorexia nervosa, and more than half of all patients with bulimia, are bewildered by their emotional feelings and have great difficulty describing them” 

The Body Keeps the Score, pp. 98-99

With this level of disconnect from your physical sensations, any subtle signals your nervous system might be trying to send you regarding potential threats will probably go unnoticed until they become severe. And since the brain’s main way of alerting us to danger is through pain, it’s only logical that a recovering dieter may be at greater risk of persistent pain symptoms.

2. Body distrust leads to chronic stress

It’s easy to see how the pattern of weight fixation can lead to chronic worry and stress. As if paying our bills, raising responsible children and supporting our loved ones wasn’t enough of a collective burden, we somehow justify allocating energy and resources to an ongoing battle with our bodies. We see people around us who seem to handle all the important stuff AND have six-pack abs and we consider it a personal failing rather than a matter of simple genetics. We marvel at the beauty of seashells that show up in all shapes and sizes and yet expect the human form to stay within a limited range of acceptable characteristics. It’s no wonder that roughly half of U.S. adults have been on a diet in the past year. Our ability to be influenced by the multi-billion-dollar diet industry has grown exponentially in recent years through social media-provoked comparison behavior and the propagation of diets dressed up as “wellness.”

When you get trapped in a cycle of hating your own body, the result may be an effect very similar to trauma. Much like a person experiencing abuse may describe physical dissociation such that feel they are outside of themselves, a person with body dysmorphia must distance themselves from their physical vessel in order to successfully punish it through under-eating and overexercising. The sympathetic nervous system–our “fight or flight” mechanism–doesn’t know the difference between fear of a dangerous predator and fear of our inability to resist chocolate cake. In either case we may end up with a severely dysregulated nervous system that undermines our overall sense of safety and even reduces our pain threshold.

3. Weight stigma in the medical system

To make matters worse, most people in larger bodies experience regular weight-based discrimination when seeking medical care. In addition to widespread research on this topic, I have heard many individual stories from clients and friends who sought relief from pain and were told only to lose weight. Despite the advances made by the Health at Every Size movement, whether due to a lack of imagination, laziness, or sheer incompetence; medical professionals consistently sidestep complex diagnostic pathways in favor of a simple prescription to lose weight. 

In the worst case scenario, something as time-sensitive as cancer might get overlooked, in the best case scenario, this medical advice only serves to exacerbate previously described body shame, leading the person away from overall health and well-being to detrimental weight cycling and stress. Many of my clients have been going through life feeling as though their physical discomfort was somehow their own fault. Even I had moments–especially when diagnosed with plantar fasciitis–where my internal monologue told me I “did this to myself.” Everything I found on the internet pointed to weight gain as a likely culprit for this debilitating foot pain. Luckily I found supportive and informed providers who continued to help me through without ever pointing to weight loss as a solution. But even with everything I know about the demonstrated ineffectiveness of weight-focused health approaches, I couldn’t help but feel guilty. I am sure there was a part of me that wanted to believe I could be in control of my body. It’s an enticing proposal – but it simply isn’t true. And leading people to believe that they can shrink themselves to fit an arbitrary norm is downright irresponsible, not to mention damaging. Where else can a person turn if even clinicians have no other solutions to offer?

I am proud to say that while I have gained more weight than ever before and my medical records now label me as “obese,” I experience less persistent pain than I have in almost 20 years. I used to be unable to sit in wooden chairs for fear of ensuing tailbone pain. I fretted over the many days I would be incapacitated after a long car ride or flight. I was fearful that doing simple tasks like washing my clothes or going to the grocery store would send me to the couch in spasms. But it has been more than two years since I worried about any of these things and I don’t think it’s a coincidence that I also quit my last diet roughly three years ago. I may only be one person but I don’t believe my story is singular. With the knowledge that stress is a leading cause of premature death, we ought to focus on taking care of our sense of safety and security; not tearing ourselves apart from the inside out.