What is your opinion on weight? When you encounter somebody who is overweight, do you assume that they are unhealthy? Do you judge them and assume that they eat the wrong foods, eat too much and/or don't exercise? The sad reality is that most overweight people are made to feel like they need to lose weight to be healthy, and when they can't seem to shed the pounds (hint hint: it's heavily DNA and environment related) they can really take a big confidence knock, and guess what... potentially resort to food to deal with their emotions. What's more, there is no data supporting the idea that weight causes ill-health. So what is the cause? Could it be a more constructive approach to eliminate this stigma around weight?
Weight inclusive vs weight normative
The weight inclusive approach is one that aims to eliminate the stigmas surrounding weight, by recommending that we recognise our biases towards it and discriminatory actions. In other words, we want health care practitioners (HCPs) to stop assuming that people with higher weights must have diseases associated with obesity, while lower-weight patients do not (this is what we refer to as the 'weight normative' approach).
The weight normative approach to health care priorities weight as the main determinant of health and this leads to HCPs prescribing weight loss to an individual, without first taking into consideration more important factors in an individuals health and well being.
What's wrong with the weight normative approach?
When we look at the scientific research, we can see that there is a correlation between obesity-related diseases and a BMI over 30. However, the data does not support the belief that BMI causes poor health and instead factors other than weight can partially or fully explain these links between BMI and health. For example, exercise, nutrition, insulin resistance and weight stigma.
We now know that genetic and involuntary environmental factors contributing to body weight heavily outweigh voluntary life choices, so just because somebody is overweight it doesn't mean they are not engaging in healthy activities like regular exercise and good nutrition.
The issue with the weight normative approach is that it creates negative judgements on higher-weight individuals by encouraging the idea that higher individuals are unhealthy as well as a burden on society, and that weight can be controlled through will power.
We now even know that our bodies defend their optimum weight with a biological system that reacts to a shortage of calories. If a diet too low in calories is detected, our bodies are able to lower metabolism, increase hunger and basically drive us food crazy! On top of this, if an individual continuously fails to maintain a 'healthy weight' then practicing those important healthy behaviours starts to appear quite pointless.
These factors combined make it particularly hard to lose weight, which is why those trying to shed the pounds can give up easily and develop low self-esteem.
What the data says about weight loss...
Although there are a huge variety of diets that result in initial weight loss, participants 'almost always fail to maintain the behaviour changes that brought them these positive results' (5). Failing at diets is also associated with weight cycling (A.K.A. yoyo dieting) , as well as increasing the likelihood of binge eating disorder and bulimia.
This kind of weight cycling has shown to directly increase the chances of health and mental wellbeing issues. A study found that men and women had much greater emotional distress when weight cycling, especially if they expected greater happiness in their social and personal lives from weight loss too.
Weight stigma refers to the negative connotations around being a higher weight individual. This includes the attitudes and beliefs that are shown through stereotyping, rejecting, prejudice and discrimination against these people. We don't even realise the impact that weight stigma has on these individuals, feeding into the cycle of reduced mental wellbeing and weight gain.
Did you know that weight stigma is associated with higher consumption of calories? This shows the impact that our society is having on the higher-weight individuals, contrary to what we may believe about motivating them to lose weight.
So, Why go weight inclusive?
A weight inclusive approach removes the pressure on an individual to lose weight, and instead promotes the adoption of healthy habits such as pleasurable movement and gentle nutrition. This way, the blame for failure to lose weight is placed on the gruelling process of weight loss rather than on the individual.
Health at every size (HAES) promotes intuitive eating based on research showing that people who respond to physiological hunger and satiety cues and pay attention to how food affects the body (e.g. in terms of energy) have greater wellbeing.
Years of dieting or eating disorders can in fact disrupt these hunger and satiety cues, which is why many people need help recognising and relying on these cues again. If this sounds like something you are familiar with, don't be shy and drop me a message. As an intuitive eating coach, I will help you regain a healthy relationship with yourself, your body and with all food.
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L. Bacon, Health at Every Size, Benbella Books, Dallas, Tex, USA, 2010.
National Association to Advance Fat Acceptance, Guidelines for Healthcare Providers WhoTreatfatPatients,2012, http://issuu.com/naafa/docs/naafa_healthcarep_guidelines_2011_v06_screencut.
P. S. MacLean, A. Bergouignan, M. Cornier, and M. R. Jackman, “Biology’s response to dieting: the impetus for weight regain,” American Journal of Physiology: Regulatory Integrative and Comparative Physiology, vol. 301, no. 3, pp. R581–R600, 2011.
R. W. Jeffery, L. H. Epstein, G. T. Wilson et al., “Long-term maintenance of weight loss: current status,” Health Psychology, vol. 19, no. 1, pp. 5–16, 2000.