Weight-centered healthcare is the norm, but should it be?
Healthcare professionals (RDs like myself included) are generally taught to promote weight loss to improve various issues like blood pressure, heart health, kidney function, and diabetes. Although short-term success may be achieved with weight loss of 5-10% in these and other diseases, the truth is that the weight generally comes back within a few years or less. Then, you're back to square one and on the next diet.
But what if we shifted from weight-centered care to health-centered care? You may think that these two terms are one-in-the-same, but you would be wrong (sorry)! You may not know it, but people living in larger bodies often do not receive the same level of care that someone in a smaller body does due to bias and weight stigma. Due to education and training, some healthcare professionals will completely dismiss complaints from those with larger bodies or higher BMIs and simply tell that person to lose weight to solve all of their problems.
Recent research is proving that weight loss isn't always the answer.
You've probably heard of The Biggest Loser (is that show still on?). If you haven't, it was a show about seeing who could lose the most weight in a short and unhealthy amount of time to win a bunch of money. Entertaining? Sure. Practical? No way! The participants were put on diets that were not providing nearly enough food and were also forced to exercise intensely and frequently. If you are like me, you may be wondering what those people are up to now. Well, this study will give you an idea of what has happened to 14 of them. Basically, most of the study participants regained the weight lost on the show ("all but one subject regained some of the weight lost during the competition and 5 subjects were within 1% of their baseline weight or above"). Another interesting point from the study was that blood sugar was not improved and was actually often worse 6 years after completing the show when compared to baselines.
This review of weight-normative versus weight-inclusive healthcare found that the focus on weight in the weight-normative style of care creates stigma in both society and among health professionals and this can result in poor or missed diagnoses. The paper goes on to call the continued use of weight loss as a prescription for health as unethical, especially when knowing the associated outcomes of weight re-gain and poorer mental health and well-being. People may assume that higher weight people are unhealthy and lower weight people are healthy, but we know that isn't always true. Interestingly, this other study found that underweight people were more likely to pass after a heart attack than those considered overweight.
The prevalence of dieting has increased along with the prevalence of obesity.
Although it sounds a bit backwards, dieting more times than not leads to weight gain eventually. Sure, weight loss is possible on pretty much all diets because your body is suddenly getting less calories but about 95-98% of the time the weight is re-gained within 3-4 years. This means that any initial improvements in one's health due to losing weight are eventually lost. Not only that, but there is a psychological toll that occurs.
I've talked about it before, but diets can lead to eating disorders, or at least an unhealthy obsession with food. I know this personally but science also backs me up. Here is a quote from this review of intuitive eating: "research also indicates that these types of interventions (restrictive diets) may increase psychological distress, food/weight preoccupation, depression and dissatisfaction, prompt weight fluctuations, lower self-esteem, and embolden disordered eating." Calorie restriction from dieting creates feelings of intense hunger that can lead to binging on food. Plus, restricting calories followed by eventual overeating leads to an inability to listen to your body's innate hunger cues, making you stop trusting yourself. So then the diet ends and the weight is re-gained. Did you know that weight cycling can lead to diseases and poorer health? It may even be that the association between weight and diseases is actually due to weight cycling more than fat itself.
There is something called Health At Every Size® (HAES®).
If you haven't heard of HAES®, here is a good description from the Association for Size Diversity and Health: "The Health At Every Size® (HAES®) approach is a continuously evolving alternative to the weight-centered approach to treating clients and patients of all sizes. It is also a movement working to promote size-acceptance, to end weight discrimination, and to lesson the cultural obsession with weight loss and thinness. The HAES® approach promotes balanced eating, life-enhancing physical activity, and respect for the diversity of body shapes and sizes." This goes along with all the research already presented here. What HAES® is trying to achieve is helping people realize that there is stigma against people living in larger bodies and this can result in improper care.
We should also realize that life shouldn't be all about losing weight or trying to be in a smaller body. Diet culture tells us that being unhappy with our bodies should be motivation to lose weight on the latest diet. But body discontent is harmful for your health. It is just not possible for us to all have thin bodies, yet we still strive for that exact thing. Both HAES® and intuitive eating promote body acceptance (not necessarily loving your body but simply accepting it). Some research has suggested that body acceptance, as well as interventions like intuitive eating, is effective in reducing the risk of eating disorders due to decreased concerns about being thin and food restriction.
Intuitive eating and gentle nutrition may be the answer.
A growing amount of research is supporting intuitive eating as a lifestyle. Similar to HAES®, but technically founded first, intuitive eating really isn't anything new. It is really just how we should all be eating anyway. Intuitive eating re-teaches people to get in tune with hunger cues, learn to ditch diet culture and old food rules, move their body in a way that is enjoyable, and practice gentle nutrition. Unlike fad diets that promise quick results, becoming an intuitive eater takes time, which may be difficult for anyone who has been dieting for a while. This review worded it well: "Particularly for people with a long history of dieting, other self-imposed dietary restriction, or body image concerns, it can feel very precarious to let go of old habits and attitudes and risk trying new ways of relating to food and self." The conclusion from the same review summed up the benefits of becoming an intuitive eater, especially when it comes to health and healthcare, well:
Intuitive Eating intervention may be a more promising and realistic alternative to address overweight and obesity than the conventional weight-loss treatments.
This method, in addition to meeting health goals, does not affect the integrity and welfare of the patient.
Instead, it guards people of all sizes and shapes from unhealthy weight-control behaviors that may diminish their health and wellbeing.
It takes time to undo years of dieting and ignoring your hunger, but the effects of letting go of dieting are long-term. Becoming an intuitive eater means becoming strongly connected with your internal signals. Some critics think intuitive eating means you eat whatever you want whenever you want with zero regard for nutrition, but there is no truth to that. This is where gentle nutrition comes in, which is the final but very important principle of intuitive eating. It teaches you to eat for both nourishment and enjoyment. When you are completely at peace with food, you will learn that your body craves nourishing foods like fruits and vegetables along with fun foods like chocolate and chips. It is a balance of eating a variety of foods based on what sounds good and feels good for your body.
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