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SALT LAKE CITY — When I first started practicing as a registered dietitian over 13 years ago, I worked at a weight loss resort. I learned a lot from that experience, in particular from the guests themselves. I listened to their stories and heard about their struggles. I saw the weight cycling that is so common with dieting and food restriction, as well as the shame spiral that happened with each diet attempt.
I practiced nutrition how the medical community has been taught to practice — using BMI to assess health, recommending weight loss for those who were "overweight" or "obese," and using diets, restriction and calorie counting to get them there. I truly felt like I was helping.
But over time, as I observed the obsession and preoccupation with weight and food rules, I wondered if I was part of the problem rather than the solution. It didn’t feel right for anyone to have to live that way, especially in the name of health. What I was seeing should never be described as healthy.
Essentially, I saw the damage that weight bias and weight stigma can have on someone’s health. Because of their own internalized weight bias, an individual may feel they deserve to be labeled overweight or obese and need to be told to lose weight. They likely don’t realize they are being stigmatized or at all aware how that stigma is only encouraging body dissatisfaction and disordered eating patterns.
Focusing on weight loss doesn't work long term
Conventional thought is that body discontent motivates someone toward healthy behaviors. Mounting evidence and clinical practice find the opposite — body discontent is associated with disordered eating patterns, binge eating, lower levels of physical activity and increased weight gain over time.
For these reasons and more —including delayed health care, weight cycling, increased psychological and emotional stress, increased inflammation, etc. — weight stigma is actually worse for someone’s health than the weight itself. If we are truly concerned with the health of an individual, we will treat them as a whole person rather than treating their weight. Very real and harmful health consequences happen when clinicians — or any of us — are blinded by weight bias.
Harmful labels: are you using them?
Stigmatization happens when we pathologize weight or body size, encourage the fear of fat or dehumanize the individual. You may be surprised to find that encouraging weight loss or labeling someone "overweight" or "obese" is in fact weight stigma. Using words like "weight control" and "weight management" would also apply.
Instead, we can engage in conversations about weight and size by using terms like "weight concerns", "higher weight" or "fat." These types of terms are weight-neutral, or terms that would only describe body size.
Ignore the number on the scale
Placing value on weight loss causes widespread anxiety about weight for everybody of every size. It’s hard to see weight loss as a positive goal for anyone when we recognize that no method has been proven to reduce weight long term for a significant amount of people.
Weight cycling is the actual outcome, which causes inflammation and increased risk for hypertension, insulin resistance and high cholesterol. It also increases the individual’s set point or the genetically predetermined weight range where the body functions most optimally.
You’d be hard pressed to find any situation which warrants placing value on weight loss. Even if the goal is to manage a health condition, many nutrition interventions can change metabolic profiles within days (blood sugar for example), before any significant weight loss. We can treat the condition, not the weight.
By not placing emphasis on weight control or encouraging judgment about food choices, we can provide environments that are conducive to healing disordered eating and improving body image. Those environments can be found in our homes, in our workplaces and in medical practices.
On the other hand, using weight as an indicator of health assumes that whatever behavior is necessary to lose weight is automatically a healthy behavior. That is what encourages disordered eating patterns — they appear healthy because of weight loss.
The best way to a healthy weight
A healthy weight will not be one found through restriction, extremes, manipulation and/or preoccupation. Instead, from a nutrition perspective, let’s establish nourishing, adequate, consistent and satisfying food patterns (with no strings attached) and trust that our body is already fighting hard to protect our natural and most optimal body size.
A weight-inclusive approach is the belief that when given access to nonstigmatizing health care, we can maintain a healthy body and achieve a state of well-being regardless of our size. Research supports this approach, clinical practice supports this approach, and I know that we will find better health outcomes as we practice this approach.
Emily Fonnesbeck is a Registered Dietitian with her own private practice in Logan, Utah, working with both local and virtual clients. Her treatment specialities include disordered eating, body image and digestive issues. www.emilyfonnesbeck.com