Healthism: When a focus on healthy living becomes problematic

What is healthism?

“Healthism” was coined in 1980 by Robert Crawford in the International Journal of Health Services: Planning, Administration, and Evaluation. Crawford was concerned about the new health consciousness and interest in wellness and holistic health permeating society in the 1970s.¹

He does offer a "healthism" definition, describing it as “the preoccupation with personal health as a primary—often the primary—focus for the definition and achievement of well-being; a goal which is to be obtained primarily through the modification of lifestyles, with or without therapeutic help.”¹ Someone who follows these beliefs could be called a "healthist."

What a healthist believes

Although disease is complex and multi-faceted with many different intersecting influences, a healthist views health through the lens of personal responsibility and control.

Healthism blames the individual’s health on their behavior and choices and shames the individual for not being able to do all the right things when their efforts inevitably fail. The individual, then, is viewed as a failure and morally inferior.

Healthism does not consider the biological, psychological, cultural, and sociological factors influencing physical and mental health, such as:¹

• Poverty
• Lack of access to care
• Racism
• Misogyny
• Transphobia
• Homophobia
• Fatphobia
• Weight stigma
• Trauma

“For the healthist, the solution rests within the individual’s determination to resist culture, advertising, institutional and environmental constraints, disease agents, or, simply, lazy or poor personal habits.”¹

To that end, healthism is a belief or attitude that views personal health as within that person’s control, entirely attainable, and a moral good. As such, people are judged based on their health. Meanwhile, people who engage in deprivation, such as dieting, fasting, detoxing, or juice cleanses, are often viewed as good and moral.

Healthism in common language

Combined with the rise of diet culture, healthism and healthist beliefs have deeply penetrated society, even influencing how we speak.

So many things we say regarding food consumption and exercise are steeped in healthist attitudes. We may be parroting these thoughts without even realizing it. This can be particularly dangerous, as your words can influence how you think.³

How healthism harms marginalized people 

Healthism is, by its nature, discriminatory. Subtle as they may be, the thoughts involved in dividing the world into "moral, healthy" people and "bad, unhealthy" people can have an insidious and stigmatizing effect, harming people living in larger bodies, as well as many other marginalized identities.

This perhaps most directly impacts fat people. These individuals are subject to weight stigma in many different settings, including school, work, healthcare, and even in the home. Family, friends, teachers, coaches, colleagues, and even healthcare providers may express healthist attitudes toward people in larger bodies. Fat people are often viewed and labeled as immoral, irresponsible, lazy, weak, and so much more, and this can lead to real emotional and psychological damage.⁴ 

Those passing these judgments often cite harmful healthism beliefs, such as that they’re merely concerned for the person’s health. However, this is based on the false idea that weight is directly related to health, a fact repeatedly debunked by research.^5,6

Healthism and other marginalized populations

Healthism doesn’t just harm people living in larger bodies—it is used to maintain ableism, racism, transphobia, classism, and more. For example, healthist beliefs that health is solely in an individual's control can work to stigmatize people struggling with a substance use disorder or addiction, focusing on the person's actions and ignoring factors about their genetics and environment.

Beliefs promoted by healthism could lead someone to focus on the side effects or potential consequences of hormone replacement therapy (HRT), criticizing those who seek it out for damaging their health, as opposed to looking at the potential life-saving qualities of these therapies.

People who are pregnant and new parents also often experience the harmful effects of healthism, as everything from how to give birth to how and what to feed your child has become subject to broader societal debate. Specific pursuits, such as losing “baby weight” or getting your "pre-pregnancy body" back, may also be pushed by those holding healthist beliefs.

Overall, healthism views health as a personal responsibility. So, according to those who buy into this damaging attitude, if members of marginalized communities have medical conditions or poor health, then they must be “irresponsible” or “lazy.” As such, healthism can contribute to stereotyping, stigmatization, and discrimination upheld by those who have power and privilege.

Healthism is a systemic issue

As much as healthism works to assign personal responsibility to individuals, the attitude takes on a much more significant role, influencing the way things work in culture and society at large. Healthist views can promote victim-blaming, reward those with privilege, and compound inequities in the healthcare system.

For example, before the Affordable Care Act was passed in 2010, U.S. insurance companies were legally allowed to deny insurance to those with “pre-existing conditions," including:⁷

• HIV/AIDS
• Diabetes
• Obesity
• Epilepsy
• Pregnancy
• Heart failure
• Severe mental health disorders

The idea that those with these conditions did not deserve insurance coverage is supported by healthist notions that health is the sole responsibility of an individual. But in reality, it meant those potentially needing the most help were often denied it.

Those who view healthism through a social justice lens often consider it to be a distraction from more pressing priorities, such as health equity, climate justice, and police violence against people who are Black and Brown. They also consider it to be a tool to further oppress and marginalize those who don’t fit the healthist ideals, such as those living in larger bodies or those with chronic illnesses.

How to challenge your own biases

Much like diet culture and weight stigma, healthism is so prevalent in our society that we likely don’t even realize all the ways in which we perpetuate it. And we’re all guilty of it. But it's never too late to change.

There are ways to unlearn our internalized harmful attitudes and change our outlook and behaviors. At the end of the day, no matter how we’ve been socialized, it’s up to us to educate ourselves and do better. And we start doing better by challenging our beliefs about other people, their health, and how we treat them.

Ultimately, challenging your healthist beliefs and behaviors and other implicit biases can help you approach the world from a more compassionate, empathetic, and inclusive place and initiate change.² It can also help you approach people who promote healthism and have other harmful beliefs. 

However, just as health is not an individual problem, dismantling healthism is not up to individuals. Deconstructing and eradicating healthism requires significant structural changes in our culture and society, and individuals must work together to achieve those goals. We can start by doing our part.