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I am very excited to tell you about an epic new article that has appeared in the Journal of Obesity. This article called, “The Weight-Inclusive versus Weight-Normative Approach to Health: Evaluating the Evidence for Prioritizing Well-Being over Weight Loss” reviews much of the available literature on doctors and weight loss and comes to a very firm conclusion: our medical obsession with weight loss is not making us any healthier. The article defines the difference between the Weight Inclusive and Weight Normative approaches this way:
In this paper, we review evidence that challenges the weight-normative approach for health promotion and offer evidence to support a weight-inclusive approach for health promotion. Instead of imagining that well-being is only possible at a specific weight, a weight-inclusive approach considers empirically supported practices that enhance people’s health in patient care and public health settings regardless of where they fall on the weight spectrum [1, 2, 22]. These approaches differ in the emphasis each one places on weight. While health care professionals using either approach may share some commonalities (e.g., recommending similar self-care practices), they contrast in the relative importance they place on body weight in the context of health and medical treatment, their perceptions of the malleability of weight, and how they respond to patients based on their weight.
The article is very long and rich and cites hundreds of sources. But I thought I’d pull out
10 things you can learn about weight-focused healthcare in this article:
1. Recommending weight loss is actually a less conservative approach than recommending HAES because there are negative consequences associated with weight loss attempts. Thus prescribing weight loss can go against the edict to “first do no harm”.
2. The data do not support the notion that higher BMI causes poor health outcomes.
3. Prescribing weight loss supports the notion that permanent weight loss is largely under a person’s control, and that fat people cost society more money. Neither of these notions are supported by the data.
4. Weight bias not only exists, but is common in clinical environments. This is a part of the general increase in weight stigma in the wider world, and weight stigma is dangerous to your health.
5. Not only does weight loss not work on a permanent basis, but weight cycling (the common result of repeated weight loss attempts) is dangerous for your body.
6. Obsession with weight loss has led to an increase in eating disorders.
7. But there is another way. The weight inclusive approach focuses on weight as a simple data point in a much larger view on health and focuses on positive behaviors.
8. The basic principles of the weight inclusive approach are these:
1)Do no harm.
(2)Appreciate that bodies naturally come in a variety of shapes and sizes, and ensure optimal health and well-being is provided to everyone, regardless of their weight.
(3)Given that health is multidimensional, maintain a holistic focus (i.e., examine a number of behavioral and modifiable health indices rather than a predominant focus on weight/weight loss).
(4)Encourage a process-focus (rather than end-goals) for day-to-day quality of life. For example, people can notice what makes their bodies rested and energetic today and incorporate that into future behavior, but also notice if it changes; they realize that well-being is dynamic rather than fixed. They keep adjusting what they know about their changing bodies.
(5)Critically evaluate the empirical evidence for weight loss treatments and incorporate sustainable, empirically supported practices into prevention and treatment efforts, calling for more research where the evidence is weak or absent.
(6)Create healthful, individualized practices and environments that are sustainable (e.g., regular pleasurable exercise, regular intake of foods high in nutrients, adequate sleep and rest, adequate hydration). Where possible, work with families, schools, and communities to provide safe physical activity resources and ways to improve access to nutrient-dense foods.
(7)Where possible, work to increase health access, autonomy, and social justice for all individuals along the entire weight spectrum. Trust that people move toward greater health when given access to stigma-free health care and opportunities (e.g., gyms with equipment for people of all sizes; trainers who focus on increments in strength, flexibility, V02 Max, and pleasure rather than weight and weight loss).
9. Along with the data that shows the weight normalization (weight-loss focused) approach is ineffective and harmful, is significant data showing the weight inclusive (HAES-oriented) approach is more successful, and that it does not share the negative side effects of the weight normalization approach.
10. With these thoughts in mind, it makes sense to move to a weight inclusive approach in both personal and public health and actively work to reduce stigma both within and outside of the world of medicine.
I urge you to take some time to work your way through this epic piece of work. And I urge you to print a copy and bookmark this for sharing at a later date. Maybe you could take this along to your next doctor appointment. Maybe you have a friend that is struggling with health care that can use the data to his advantage. In any case, I’m very, very excited about this and couldn’t wait to share it with you.
Jeanette DePatie (AKA The Fat Chick)