By Alex Raymond, Rd, LD and Caroline Best, student intern
As a junior in a dietetics programs, I’ve started to move into taking more nutrition education courses. After your first year or two in the program filled with science and nutrition classes, courses that teach you how to best interact and educate nutrition patients are integrated into your schedule. A patient approach we’ve spent time learning about is the weight inclusive approach.
So what exactly is the weight-inclusive approach?
It is the belief that when provided with access to health care that is non-stigmatizing. Each individual does have the ability to maintain a healthy body. And achieve a state of well-being independent of their weight. The approach moves away from placing blame on the individual for being unable to lose weight, and it instead blames the weight loss process. It allows for a decrease in weight stigma and body shaming. The focus is on an overall improvement to psychological well-being. The weight-inclusive approach does not just apply to those who work as dietitians or in the nutrition field. It applies to everyone within the health care community including therapists, MDs, PAs, and everyone else.
So why is the weight inclusive approach being taught as the standard for patient care?
The big reason is that it decreases body shaming. The goal is to reduce negative self-image in patients. Weight can be impacted by involuntary and genetic environmental conditions. These conditions can outweigh voluntary lifestyle choices. Therefore, promoting the public health message of “maintaining a healthy weight” causes these individuals who are unable to reach their weight loss goals (or better yet, society’s weight loss goals) to feel helpless, shameful and negative about themselves and their body.
In addition, the weight-inclusive approach is linked to eliminating weight cycling and unsustainable weight loss.
What is weight cycling? Basically, another word for yo-yo dieting. The idea of losing the weight on a diet, and then gaining it back after. Then losing it again, then gaining it back…etc. The majority of individuals who take the initiative to lose weight are unable to maintain their lower weight. About 80% of people regain at least part of it within the year. 95% will regain in about 5 years. This leads to frustration and lower self-image . As well as a slowed metabolism, making weight loss (the original goal) being all the more difficult.
In addition, there is absolutely no evidence that shaming someone for their weight helps them improve their health.
BUT there is tons of evidence that focusing on health independent of weight does lead to healthier habits. Based on current evidence, any sort of shaming language from any medical professional is absolutely inappropriate, and even detrimental, to use with a patient
Lastly, the weight-inclusive approach reduces the risk of eating disorders.
The rigidity needed to retain a weight suppressed state may cause individuals who lose weight to develop eating disorders upon breaking t the diet. Very rigid dieting tends to be disrupted by episodes of binge eating. This can further lead to episodes of purging to counter weigh for the excess calories. A relevant statistic here is that 81% of 10-year-olds admit to dieting, binge eating, or a fear of getting fat. And we are now seeing eating disorders in children as young as five years old.
There’s obviously a difference in understanding a method and putting it into practice. So as one learns more about the benefits of using a weight-inclusive approach, the next question is how to best implement it.
Follow the Health at Every Size (HAES) model which:
- Rejects basing health on weight, BMI and size and the myth that weight results only from personal choices
- Depends- on evidence that weight results from uncontrollable environmental and genetic factors.
- Appreciates -that bodies are naturally of different sizes and shapes.
- Addresses– the importance of improving health care access for everyone.
The HAES Principles:
These are the HAES principles as defined by the HAES website. We strongly encourage checking the website out for more info, https://www.sizediversityandhealth.org/content.asp?id=76.
- Weight Inclusivity: Accept and respect the inherent diversity of body shapes and sizes. Reject the idealizing or pathologizing of specific weights.
- Health Enhancement: Support health policies that improve and equalize access to information and services, and personal practices that improve human well-being, including attention to individual physical, economic, social, spiritual, emotional, and other needs.
- Respectful Care: Acknowledge our biases. Work to end weight discrimination, weight stigma, and weight bias. Provide information and services from an understanding that socio-economic status, race, gender, sexual orientation, age, and other identities impact weight stigma, and support environments that address these inequities.
- Eating for Well-being: Promote flexible, individualized eating based on hunger, satiety, nutritional needs, and pleasure, rather than any externally regulated eating plan focused on weight control.
- Life-Enhancing Movement: Support physical activities that allow people of all sizes, abilities, and interests to engage in enjoyable movement, to the degree that they choose.
When using the weight inclusive approach there are some general guidelines to follow on what to do and what not to to.
What to do:
- Do encourage self-care practices and internal body focus.
- Encourage a positive view of the body.
- Help patients appreciate their bodies.
- Do help patients stop shaming themselves.
What not to do:
- Don’t praise weight loss- “Wow, you lost weight, that’s great.”
- Do not respond to weight gain by going straight for weight loss recommendations.
- Put NO emphasis on externals and appearance.
- Do not show frustration when a patient fails to lose weight/gains weight.
I hope the weight-inclusive approach is going to become more widely used.
More and more evidence supports the use of the method. And the weight-inclusive approach gets rid of the outdated and incorrect idea that weight is the best measure of health. It instead focuses on health regardless of body size, which is an approach linked to increased success and self-efficacy of patients. A final suggestions to best follow the approach is to create a non-stigmatizing environment.
- Have furniture to fit all sizes
- Offer medical equipment and gowns to accommodate individuals in larger bodies
- Don’t do pubic weigh-ins
- Educate nurses on how to respond if someone rejects being weighed
- Remember, your patients have the right to reject being weighed at your office, please respect that.
Final Thoughts from Alex Raymond, Empowered Eating Dietitian :
I applaud Virginia Tech teaching their dietetic students about this topic!! And as wonderful as it is that Caroline has learned about the weight-inclusive approach at her school, I do want to note that this is not the norm. And we still have a long way to go in reducing the stigma in our health-care world in regards to body size. Weight-focused approach is still the focus unfortunately. If you are a health-care provider reading this blog, I strongly encourage you to educate yourself on the HAES principles and how you can treat your clients without focusing on weight. Some of the advice given to people in larger bodies would NEVER be given to someone in a straight-sized body, in fact, it may even be considered disordered behavior. Regardless of someone’s body size, they deserve quality care, compassion and respect every time they walk into your door.