Chasing a moving target

Five years ago, a staff member in a Miami office building dialed my number and handed the phone off to someone I love more than almost anyone on earth. Her voice quaking with sobs, she forced out the words “I think I’m dying” before the staffer took the phone back from her and ended the call. I suppose her fear and agony was warranted; she had just undergone a “Brazilian Butt Lift” — a combination of liposuction and fat grafting designed to give the patient an ultra-curvy hourglass silhouette. By the time she went under the knife in 2021, the BBL was the fastest-growing procedure in the United States. Over 60,000 people went under the knife that year in order to receive what plastic surgery researchers now describe as the deadliest cosmetic procedure on earth.

Her grueling recovery included several months attending the University of Iowa’s wound clinic to address a liposuction site that had reopened, about 5 months home from work, and family members pitching in to assist with her activities of daily living. She developed additional complications, amassing over a liter of fluid on one side due to internal infection and suffering from necrosis (tissue death). A year after her procedure, she struggled to find a physician willing to help her address her now painful, lumpy, and literally hot to the touch infected rear end. When she contacted the surgery center where she had undergone the procedure in the first place, her surgeon suggested she undergo the same procedure AGAIN in order to add more fat to the other side. By some miracle (and some networking) a local plastic surgeon finally agreed to take a look. The aggressive approach taken by her original surgeon had resulted in severe and untreated infection. Had her condition continued without treatment, she could have experienced sepsis, organ damage, or death.

What’s truly unsettling about this story is that the BBL trend is already over. The national aesthetic obsession has shifted from the early 50s hourglass to the aerobic 80s, from the 2012 “thigh gap” phenomenon to the 2021 BBL, and has now come careening back to featherweight status with “skinnytok” influencers touting their minimal food intake and jutting hipbones online.

From its earliest roots, American diet culture has treated both food and the human body as moral problems to be managed rather than sources of nourishment or pleasure. Early diet reformers like Sylvester Graham (minister and cracker inventor) connected restraint at the table to virtue and social worth. Over time, the idea that thin is morally superior became widely accepted as gospel truth. The notion settled into the social subconscious, shaping how people continue to perceive others (and often, how they perceive themselves).

Much like hemlines, the “ideal” body type has fluctuated with other social factors, like the state of the economy or who wields the most political power at a given point in time. However, social media has collapsed the timeline on how quickly a trend takes over. When my generation was small, we had to wait for Saturday cartoons to be explicitly advertised to. For the young and impressionable now, the deluge is constant, and often unmonitored, and this is where ED (eating disorder) content has the most potential to do serious harm.

Several years ago, the term being used for content from creators promoting and glorifying disordered eating was called “pro-Ana” (short for “pro-anorexia”.) The pro-Ana sites started on Tumblr long before short form video content took control of our collective attention span, and their reach didn’t come close to what is happening today. Type “skinnytok” into the search bar of TikTok, and you’re confronted with a message from the platform suggesting you may be at risk for disordered eating, and directing you to a hotline where you can seek professional help. Turns out, TikTok opted to ban the hashtag “skinnytok” in June of last year following pressure from European regulators concerned about the massive quantity of content encouraging disordered eating to an all-ages audience. Unfortunately, blocking one hashtag isn’t bulletproof. It still is very easy to create the same content with a different caption and continue to post.

The trouble with algorithms is they aren’t designed to distinguish between who is and is not vulnerable to dangerous messaging. Their only function is to keep you on the site for as long as possible to drive revenue; so if your preteen hovers a little too long on a video promoting disordered eating, chances are there will be several more videos with similar messaging headed to their device in short order.

In the midst of MAGA driven mistrust in public health institutions and general confusion over who is genuinely qualified to provide accurate information, people are making real decisions about their health in an environment where authority is increasingly unclear. Added to the historical context of shame related to body type and appetite, the mass adoption of GLP-1 medications as a weight loss tool, and repeated exposure to ED content, our youngest generation is facing a very different landscape than we did. (We may have dealt with Fen-phen and Y2K body shaming, but we didn’t have a pipeline in our back pocket … we had to read the magazine covers in the checkout line. They were simpler times.)

The BBL took the world by storm because it offered a quick solution to what we had been persuaded was an urgent problem. Beauty is and has always been more than an aesthetic; in our society, to be beautiful is to be desirable, valuable, marketable, and relevant. Women who wear makeup get paid more for the same work, as do men who are taller. Beauty is as much about access and power as it is about anything else, and that becomes more clear as we monetize mass consumption of lightning fast content day after day after day. No wonder so many people were willing to risk it all for the “perfect” measurements …

It’s just that the goalposts are moving so much faster now. How we talk about food, weight, and health to our kids matters. How we talk to and about ourselves matters. If I have learned anything from 25 years in the mom game, it’s that kids will do what you do and not what you say. It is our responsibility to model what real wellness looks like, in all of its glorious biodiversity, rather than teaching the next generation to mistake appearance for health.

Don’t just look well, BE well.

If you or someone you know may be at risk for or living with an eating disorder, help is available. Contact the National Alliance for Eating Disorders Hotline: 1-866-662-1235

Sofia DeMartino is a Gazette editorial fellow. sofia.demartino@thegazette.com