As a nutritional psychologist, much of what I do looks at the overlap between food and mental health and the role of food and nutrition on brain function, disordered eating, and our psychological relationships with food. In the last few years, I’ve noticed a striking pattern in the descriptions of a particularly worrying thought about bloating after eating, that seems to occur in patients with a range of different disordered eating habits. Most of these patients are in their twenties, making them members of a generation that has had access to the internet from a young age.
Time and again my patients talk about the distress of feeling “bloated after eating.” When I ask them to explain, our conversation usually goes something like this:
Patient: After I ate my tummy got bloated.
Me: How long did that last?
Patient: A couple of hours.
Me: Was there any pain?
Me: Did you feel nauseous?
Me: How often does this happen?
Patient: Only after I eat.
I’ve had clients, in their frustration, stand up, lift their shirts, and show me the post-meal “bloating” that was making them feel so bad. I look. I don’t see any signs of bloating. Over time, I’ve come to suspect that what my clients find so troubling are the results of the process of eating and digesting food—you know, the mild distention from the presence of foods and liquids, gurgling, maybe some gas. I believe this is linked to the medicalization of food and the body, as well as strong social stigma around fat and fatness, but more on that shortly. First I want to talk a little about what healthy digestion looks and feels like.
A reminder: bloating is a normal part of the digestion process.
As Rudolph Bedford, M.D., director of gastroenterology at Providence Saint John’s Health Center in Santa Monica, California, explains, after you eat, your stomach breaks food down into digestible-sized pieces, so that the food can then start to flow through the small intestine, where most of the digestive action takes places. The breakdown of carbohydrates and the fermentation of dietary fiber may produce gas, which expands (think of balloon filling with air), which in turn causes bloating. This bloating generally passes after a bit of time or after gas is passed, and is often simply part of your body working effectively to turn food into fuel.
It’s important to note that there are certain conditions that are associated with uncomfortable, persistent, severe bloating after eating. Dr. Bedford says that the bloating that comes with conditions like irritable bowel syndrome, Celiac disease, or gluten sensitivity are accompanied by discomfort and cramping, and aren’t likely to be confused with mild post-meal bloating (that doesn’t come with any other symptoms or cause more than minor discomfort).
As a professional in the nutritional world, I’ve seen a worrisome increase in the amount of my patients who think any bloating at all is bad. I’m not alone.
I’ve asked colleagues (in nutrition and mental health) whether they have experience with clients who complain in particular about bloating, and many reported clients and patients asking for ways to “avoid the bloat.” Time and again—even after digestive disorders have been ruled out—clients remain convinced that if their stomachs are not flat at all times, there is something (or they had done something) wrong.
Are gastroenterologists noticing any similar trends? When asked about patients at his practice, Dr. Bedford said he experiences what I described above “all the time.” (Actually he put it more emphatically: “All. The. Time.”) He says that in the last decade he’s seen an increase in patients who come to his office complaining of bloating; patients who, most of the time, don’t have other symptoms that would indicate anything besides normal digestion.
A cursory look at the evidence seems to match up with Dr. Bedford’s observation. Not surprisingly, in roughly the same 10-year period that Dr. Bedford refers to, research that looks at gut health has risen dramatically. A PubMed search for the term “gut microbiota” for 2007 reveals just 67 papers. In 2017 that figure was 2,688, with 2018 on track to beat that total with 2011 so far. Google trends show a sharp rise in searches for “gut health” and “microbiome” over the last decade. FiveThirtyEight reports that funding on microbiome research rose from more than $ 200 million in 2012 to $ 450 million in 2014. The digestive health product industry was reportedly worth almost $ 70 billion in 2017. Clearly, people are interested in the health of their gut and reducing bloating.
But this only tells us part of the story. On image-based social media sites like Instagram, creating and consuming content about idealized bodies with #flatabs can be a huge part of the experience of using those apps, as evidenced by the popularity and wide reach of certain hashtags and posts, particularly by celebrities and influencers, featuring their bodies and their favorite body-related products. Eight years after its launch, Instagram has more than 800 million users, 68 percent of whom are women (the app reportedly is used by 31percent of U.S. women). More than half (59 percent) of internet users worldwide between the ages of 18 and 29 use Instagram. Basically, Instagram, the social network that is arguably all about how things look, is, in many ways, a young woman’s game.
Social media has also become a place to go for health and wellness tips and inspiration: In 2012, an industry survey found that 90 percent of respondents aged 18-24 would trust the health information they found on social media. There are more than a million posts on Instagram tagged “guthealth.” Invariably, it seems that a “healthy” gut is equated with a washboard flat abdomen, implying that, if your stomach isn’t, you are bloated and you need to do something to fix it. In 2017, England’s Royal Society for Public Health published a survey on the effect of social media networks on people’s mental health, ranking Instagram as the number one most detrimental to young people’s mental health and wellbeing. (Instagram, which is owned by Facebook, seems to know there’s room for improvement. The company has a Wellbeing Team charged, in large part, with making Instagram a safer, more positive online community.)
There are innumerable options that promise to address this bloating “problem.” High profile celebrities, influencers, and reality stars use Instagram to endorse flat tummy products (like detox teas, “flat tummy shakes,” and something called Boombod).
This is a potent, and problematic, combination: greater awareness of gut health and even greater access to idealized body images, both endorsing the idea that a perfectly flat stomach is the ideal for health and beauty. What it creates is a double whammy of bloating-related anxiety (often over natural and healthy occurance of digestion) for young women: if your stomach isn’t flat, either you have digestive issues and/or you’re unattractive.
That’s a problem. Exposure to idealized beauty standards can lead to body image issues and disordered eating. In addition, seeing bloating as undesirable further perpetuates the idea that fatness or bigness is inherently “bad.”
The culprit in all this is weight stigma. If thinness wasn’t so linked (if sometimes totally interchangeable) with attractiveness and even a person’s values, it’s unlikely that routine, mild stomach distention would seem worthy of a “fix” or an intervention by a doctor.
We know that exposure to images of the “thin ideal” is associated with increased body dissatisfaction, body dysmorphia, symptoms of disordered eating, and lower self-esteem. A recent UK youth survey of more than 1,000 people (ages 11-16) on body image expectations found that 62 percent of the 15-16 year-olds felt increased pressure around their physical appearance due to social media, and 58 percent of them attributing this to celebrity influence.
As someone who treats patients with disordered eating, I believe that together these factors contribute to the development of disordered eating behaviors. It is common for me to meet people who have embarked on “detoxes” or elimination diets (which, by the way should only be done under the supervision of physician and for the purpose of identifying an intolerance or allergy) in order to combat their “bloating.” Some people deliberately undereat in order to minimize any of the normal distention associated with digestion, putting them at risk for health problems and increasing their chances of developing a long-term eating disorder.
There probably isn’t that much we can do to change how companies take advantage of our collective fear of bloating, but we can demand better from ourselves and our social media communities.
As I mentioned, there are times when bloating is a sign of something to be concerned about. If you are worried, and have symptoms beyond a bigger belly immediately following food consumption, you should see your physician or a registered dietitian to rule out a gastrointestinal problem, food allergy, or intolerance—the idea shouldn’t be to “avoid the bloat,” but to understand that bloating is one symptom of a larger medical issue that needs to be addressed. But for most people who feel bloated and show no other signs of gastrointestinal distress, the distention they experience after eating is simply the gut’s response to food, which we have been encouraged to view as unattractive and undesirable through a combination of a culture obsessed with thinness and dieting, the use of vague terminology in product marketing, greater public interest in gut issues, and scaremongering social media symptom checklists.
How do we get out? We reassure ourselves that a degree of distention or bloating after eating is absolutely to be expected. We tell ourselves that we don’t need to avoid the bloat. We accept that daily shifts in the appearance of our bodies is absolutely natural. We remind each other that our bodies are our own and support each other to take care of them without comparing ourselves to a generic and irrelevant body standard. We speak out against weight bias and fat stigma. And we should stop perpetuating the myth that not having a flat stomach—whether from bloating, body composition, or anything else—is something that needs to be fixed.
Kimberley Wilson is a Chartered Psychologist working in private practice in London, UK. Her work and writing addresses the interplay between food, psychology and mental health, including Nutritional Psychiatry, disordered eating, and our social and psychological relationships with food. Listen to her podcast Food and Psych, here, and follow her on Twitter @FoodAndPsych here, and on Instagram here.