The problem with weight control
The problem with weight control
These days weight, and what to do about it, is highly controversial. For a long time, weight has been assumed by many to be an unequivocal marker of health status. There is also the pervasive assumption not only that weight itself is the problem, but also that intentional weight control is the answer. These (unfounded) beliefs continue to exacerbate weight bias, prejudice, stigma and discrimination. Dieting for weight loss and preoccupation with body shape and size is a highly culturalised phenomenon which is so widespread that it has become normative in western society. It is so deeply entrenched that alternatives to weight loss dieting and studies which show a protective effect of fatness are often met with undue scepticism and sometimes outright outrage. Not only has the effect of higher weight often been (sometimes appallingly) overstated, but there is scant long-term evidence that traditional weight loss interventions achieve what they set out to achieve. As an added blow, these interventions have been shown, where investigated, to lead to exacerbated problems with body image, depression, disordered eating and weight regain for most by five years. Restrictive dieting for weight loss is ineffective in the long term for 95% of people. Some health professionals, although well-meaning and highly trained, may be contributing to the problem.
No matter how committed someone is to attaining a lower weight, it's unlikely to be their long term outcome they experience.
No matter how committed someone is to attaining a lower weight, it's unlikely to be their long term outcome they experience.
Despite the overwhelming evidence of the ineffectiveness of intentional weight loss efforts, and complex, multifactorial pathways to higher body weight, the weight loss industry remains strong. In recent years, pharmaceutical companies have made moves to have a BMI of 30 or higher designated as an independent 'disease' state. To do this they have spent incalculable amounts of money to sway public, medical and political sentiment towards thinking of a higher body weight as a medical problem looking for an effective treatment. They fund researchers to write about higher body weight as a 'chronic, relapsing disease', an 'epidemic' and 'the chronic disease of obesity'. They created World Obesity Day to keep it on the political calendar. They fund political lobbyists across the world to push governments to perceive 'Obesity' strategies as substitutes for actual public health. They establish 'Obesity' organisations in multiple sectors, with some catering to health professionals and others to the public - all with the intention of swaying public sentiment about body weight to something people might ask their doctors for treatment for, and their government to fund treatment for. They even position themselves as weight stigma experts, without ever acknowledging their own central role in perpetuating weight stigma by medicalising and pathologising body size.
A better alternative: Weight inclusive, weight neutral care
A better alternative: Weight inclusive, weight neutral care
Weight-neutral approaches in healthcare are those that do not aim to change body weight, nor have the reliable outcome of body weight change. A number of conceptual frameworks for weight inclusive, weight neutral approaches to health exist to support ethical, health-enhancing, evidence-based healthcare, especially for larger-bodied people who are often the recipients of stigma and discrimination, including in healthcare, including ASDAH's Health at Every Size Principles. The Non-Diet Approach is the a clinical application model for use with individuals. Weight-neutral approaches such as the Non-Diet Approach have resulted in decreased body dissatisfaction, decreased disordered eating and decreased depression and lead to increased sustainable, enjoyable self-care behaviours such as eating and moving well in the long term. The Non-Diet Approach and the Non-Diet Approach model as described here were developed as part of Fiona Willer's PhD research into weight-neutral approaches in nutrition and dietetics counselling for people with weight concern.
Dietitians are very good at assessing the ‘who’, ‘what’ and ‘when’ parts of individual health improvement through nutrition. We use empirical research to understand what elements are effective in reaching this goal. The non-diet approach is an alternative answer to the question of ‘how’ this knowledge is best passed on to our patients and clients.
Dietitians are very good at assessing the ‘who’, ‘what’ and ‘when’ parts of individual health improvement through nutrition. We use empirical research to understand what elements are effective in reaching this goal. The non-diet approach is an alternative answer to the question of ‘how’ this knowledge is best passed on to our patients and clients.
There is a common belief among both health professionals and the general public that abandoning food and eating restrictions will result in food choices of poor nutritional quality, excessive energy intake and commensurate weight gain, and then assumed increased risk of chronic conditions which will further burden the health care system. This is the main criticism of weight neutral dietetics despite the widely researched and consistently poor success of traditional weight loss interventions. Most non-diet approach interventions have shown positive outcomes in physiological and psychological outcomes and BMI tends to remain relatively stable beyond the end of the intervention program.
The non-diet approach methods detailed in The Non-Diet Approach Guidebook for Dietitians (2013) were brought together by Dr Fiona Willer (Advanced Accredited Practising Dietitian, PhD) and academic in Nutrition and Dietetics as part of her PhD study into the use of health-oriented size accepting approaches by health professionals. In 2014, Fiona collaborated with Louise Adams, clinical psychologist, to develop The Non-Diet Approach Guidebook for Psychologists and Counsellors.
Time for a paradigm shift
Time for a paradigm shift
Diet Paradigm:
Inflexible, quantitative, prescriptive, rigid, perfection-seeking, good or bad foods, rules, deprivation, time-based, fear-driven, guilt-inducing, shaming, body hatred, hunger, struggle, rationalising, temptation, thought-consuming, punishing.
Diet Paradigm:
Inflexible, quantitative, prescriptive, rigid, perfection-seeking, good or bad foods, rules, deprivation, time-based, fear-driven, guilt-inducing, shaming, body hatred, hunger, struggle, rationalising, temptation, thought-consuming, punishing.
Non-Diet Paradigm:
Flexible, accepting, welcomes all foods, intuitive, qualitative, supporting, enjoyable, life balance, appreciating, comfort, confidence, variety, freedom, natural, calm, pleasurable, kindness, nurturing, grateful, nourishing, forgiving, satisfaction, trust-building.
Non-Diet Paradigm:
Flexible, accepting, welcomes all foods, intuitive, qualitative, supporting, enjoyable, life balance, appreciating, comfort, confidence, variety, freedom, natural, calm, pleasurable, kindness, nurturing, grateful, nourishing, forgiving, satisfaction, trust-building.
A note on Health at Every Size (HAES):
The terms 'Health at Every Size' and 'HAES' were originated by the Association for Size Diversity and Health (ASDAH) in 2010 and Trademarked in US Territories. ASDAH also created the Health at Every Size (HAES) Principles. The professional use of the HAES Principles was widely encouraged by ASDAH without specific licensing until late 2022 when the ASDAH leadership decided to regain control over their use and provide permission by application only. If you would like to use these terms to describe your work, please apply via www.ASDAH.org and understand that continual professional development using ASDAHs materials is likely to be required.
It is not necessary to label yourself as a HAES provider if you are using a weight inclusive approach. The HAES Principles are one of many weight inclusive frameworks. Be specific in your marketing materials and practice about the specific characteristics of the services you provide, rather than using catch phrases and popular social media hashtags as shortcuts. A detailed approach will ensure that your clients and colleagues understand your offerings more clearly. Connect with other weight inclusive practitioners and peer support groups in your area to ensure your practice remains safe, up-to-date and relevant for the communities and individuals you work with.