“I’m thinking thin!”

In the 2000 film Requiem for a Dream, that’s the hopeful refrain from Sara Goldfarb (played extravagantly by Ellen Burstyn) as she embarks on a crash diet—black coffee, hard-boiled eggs, and half a grapefruit each morning—to lose 10 lbs in 10 days. The underlying goal (because there’s always one with dieting, no one diets for its own sake): Fit into an old red dress she wants to wear when she appears on television after winning a mail-in sweepstakes1.

Spoiler alert for a 23-year old movie: She can’t stick to the diet and so she seeks medication to assist her weight loss. A doctor prescribes her a daily course of amphetamines, i.e., the diet pills du jour from when the story was set in the mid 20th century.

The results are stunning: She loses her 10 lbs and then some, but—shocker—that proves tough to sustain without increasing her dosage. Soon she’s psychotic, imagining the refrigerators talking to her and that the huckstery, infomercial-immersed host of the show she delusionally thinks she’ll be on is in her living room alongside her fantasized thin red self2, mocking the messiness of her Brighton Beach apartment. Eventually she ends up virtually vegetative.

Her plot line, more so than the other three that involve three other characters’ struggles with heroin, is what makes Requiem for Dream linger3 in my mind. Rarely does any quasi-mainstream4 movie portray diet culture for what it really is—a money-making cult that drives its followers literally insane while destroying their health.

The notions that weight loss is A) desirable for health reasons and B) sustainable have no roots in scientific evidence.5 Any substantial weight loss is regained and then some in 95% of people. This inevitable weight cycling is itself far more provably harmful than being “obese”6—in other words, by telling people to diet, doctors are essentially prescribing the thing they’re nominally trying to prevent.

Medications for weight loss have a horrible track record. I mean, look at the fucking tables in this paper—and this was before the disastrous fen-phen cocktail of the 90s. As with the destructive baldness medication Propecia, weight-loss meds are pushed on the desperate public with zeal despite their concerning side-effect profiles7 and their relatively meager benefits8. I wouldn’t trust Wegovy et al. at all given the history and the culture that made them.

The weight loss imperative thrust on “obese” patients is an aesthetic and political concern—“fat people are disgusting,” more or less—masquerading as a medical diagnosis. And its costs are immense, not just financially but also in terms of the effects on people’s physical and mental health’s and their enjoyment of life. Perfectly good and nutritious food gets branded as “sinful,” “a guilty pleasure,” or part of a “cheat day/meal.” There’s thus a religious, Puritanical thrust to the dieting madness.

And for what? There’s no reward on the other side except for short-term weight loss that’ll be reversed, people who’ll tell you look great even if your weight loss was the result of some illness (the easiest way by far to lose weight, and a hint at how unhealthy it is), and more madness counting calories and going slowly mad in your home like Sara Goldfarb.

  1. She never hears back about this contest. ↩︎

  2. This reminded me in the imagery of the Laurent Garnier song “The Man with the Red Face.” ↩︎

  3. The Cranberries? Anyone↩︎

  4. It was rated NC-17 but it’s by Darren Aronofksy, a major director who also did the awful The Whale↩︎

  5. On this point I recommend The Obesity Myth by Paul Campos. ↩︎

  6. “Obese” is not a real disease. Its only indicator—BMI—is a pseudoscientific formula made upby a literal astrologer. I recommend What’s Wrong With Fat? by Abigail Saguy on how the “obesity epidemic” was manufactured from whole cloth in the 1990s. ↩︎

  7. Propecia can cause irreversible damage to the male reproductive system. Wegovy can damage the thyroid, among other effects. Both come with an FDA “black box” warning. ↩︎

  8. Yes, even the “miracle” new diet injections plateau and reverse after a while↩︎