April 12, 2022
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Navigating diet culture while living with migraine has forced me to reassess how I think, and speak, about food.
I’m just getting settled in my neurologist’s exam room when my phone announces an incoming message in my family text thread.
“I’m starting to plan my Passover shopping,” my mother-in-law’s text reads. “We need to think about food.”
We need to think about food is often the opening line to Jewish holidays. Passover, which starts with a traditional meal ritual that often lasts hours, is no exception.
What does make Passover unique among other holidays is the 8-day removal of a particular type of food: chametz.
Chametz is defined as any food product made from wheat, barley, rye, oats, or spelt that has come into contact with water and been allowed to ferment or rise. That means bread, cake, pasta, cookies, crackers, and more are all out the window.
For a single week, it’s a manageable change, if occasionally frustrating. However, in the context of my personal history around food, it’s a challenge. It feels even more overwhelming as I sit next to the poster on my doctor’s wall that catches my attention every time I walk into the room.
“Diet and Migraine,” it proclaims, in bold, colorful letters designed to catch the eye.
It’s the word “diet” that makes me flinch every time I sit down to wait for my doctor. In a society where the word “diet” comes with ever-increasing baggage, I can never quite stop wondering why it was chosen for the poster.
As a migraine patient with a history of disordered eating, “diet” sends up immediate red flags. As a fat patient navigating a medical system full of weight bias with consequences ranging from uncomfortable to dangerous, those red flags just get redder.
Once upon a time, diet may have just been an easy shorthand for what you eat, when, and how. On a societal level, though, diet has become synonymous with food choices made to achieve a certain goal.
While that goal is often claimed to be “health,” “health” in most cases is code for “weight loss.”
Social beliefs that equate thinness to “healthy” have become prominent. Along with this, diet culture demonizes certain food choices and behaviors (often those associated with fatness or weight gain) while moralizing others (ones associated with thinness or weight loss).
Even the people whose advice we take about food are subject to vetting based on whether they fit diet culture’s definition of a voice of authority.
“As a fat dietitian, people are less likely to take me seriously than a thinner dietitian,” says Amee Stevenson, a registered dietician who brings a fat acceptance and social justice approach to her work.
“My abilities and knowledge are in question, both implicitly and explicitly because of my body size,” she says. “Clients and other professionals alike have questioned my ability to provide care and have decided not to work with me.”
In a medical setting, diet culture shows up in both subtle and obvious ways. Colorful posters that mix cheerful lettering with fine print reminding the reader that losing weight could help reduce migraine symptoms is one thing.
Doctors being more likely to report perceived negative attitudes or resistant behaviors from fat patients is another.
When I tried searching the internet for information about migraine triggers, many of the top results all focused on obesity and diet.
A 2017 meta-analysis from Johns Hopkins University School of Medicine found a correlation between being underweight and having an increased risk of migraine. And yet, resources focusing on gaining weight when you live with migraine appear to be all but nonexistent.
It’s also worth noting that while the studies examined in the Johns Hopkins analysis controlled for weight and sex, they did not take into account other factors known to impact both health and weight, such as income, stress, or trauma history.
Considering weight to be a “modifiable” risk factor, without acknowledging the many other factors that come into play, is misleading at best and actively harmful at worst.
Electronic medical systems have been reported to give doctors an “alert” that they are about to meet a patient whose weight is above a specific threshold.
Apparently, this alert happens because insurance companies require a documented effort that the doctor has advised the patient on the benefits of losing weight — regardless of the concern that brought them to the appointment.
Beyond the posters and recommendations to keep a food journal or try an elimination diet, what do researchers actually know about diet and migraine?
It turns out, actually very little. From my searching, it seems as though every recommendation about food behavior changes and reducing migraine symptoms comes with an asterisk or caveat. Much of the data on migraine triggers remains anecdotal.
Some research suggests that food choices might not even be the problem and instead, it is factors such as hunger, low blood sugar, dehydration, or even food temperature that could cause a migraine attack.
Still, the language around diet, weight, and particularly weight loss continues to creep into conversations about migraine care.
As a patient, I’ve been lucky. I’ve intentionally found a care team that works from a weight-neutral perspective, and a neurologist who respected my firm statement of disinterest in weight loss from day 1.
At the same time, as the parent of a toddler, I constantly think of ways that the beliefs and language of diet culture still make it into my habits and into the way I talk about the foods we eat.
With Passover on the horizon, I’m not looking forward to explaining to my pasta-loving 2-year-old that his favorite thing is off the menu, even if only for a little while.
Because he is too young to understand the context of family and cultural traditions, it gets even harder.
If nothing else, my experience as a patient navigating the ever-present pressures of diet culture has given me a framework for all the ways not to talk about food and food choices. From these experiences, I have been able to develop my own way of talking about food.
I have learned to focus on talking about food as nourishment and a source of energy. I try to focus on experience and memory, not restriction or shame.
From exam room posters to societal beauty standards, the world will work hard enough to send my toddler messages about what, when, and how much he should eat. He doesn’t need to hear it from me.
Medically reviewed on April 12, 2022
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