Jessica practices from within a weight-neutral or weight-inclusive paradigm. She understands the impact of weight stigma and that weight loss diets aren’t health promoting. This knowledge underpins her desire to provide nutrition therapy that focuses on health promoting behaviours, while building a positive relationship with food and the body.
What is a weight-inclusive approach?
A weight-neutral or weight-inclusive approach to health and nutrition shifts the focus away from weight and BMI being the central markers of health. Instead, it adopts a more holistic view and considers other alternatives to address the underlying causes of a person’s health issues.
Shifting the focus towards building health promoting behaviours.
With weight control put aside, people can focus on improving diet, reducing disordered eating patterns, improving exercise patterns, enhancing psychological and social wellbeing, developing positive body image skills, improving sleep patterns, and stress management (Brett, 2024). It not only provides a broader approach to health but allows people to work on improving their health in a sustainable way — regardless of what is happening to their weight. This is a point worth pausing on, since health improvements can occur independently of weight loss through behavioural changes such as those mentioned above. As Brett, et. al. put it: “A larger body size, or a high BMI, does not necessarily equal poor health”.
Your weight does not determine your worth
Another foundational aspect to this model of care concerns the respect and acceptance accorded to all body shapes and sizes. This alone can be health promoting: supporting body respect and acceptance is key to reducing the harmful impact of weight stigma. A commitment to body respect also allows people to access health care without the fear of being shamed for their weight or dietary patterns. This is vital, given that shame is a poor driver for change and can even inhibit a person’s progress.
Of course, health care ought to be health promoting and widely accessible. And as health professionals, we want to help people achieve optimal health. A weight-neutral approach is not only conducive to those goals; by rejecting a weight-centric paradigm, it also deeply respects client dignity and autonomy.
Why the weight-centric approach fails
A weight-centric approach places weight loss as the primary pathway to health. And yet, weight loss is not a behaviour; it is an outcome based on several behavioural changes.
Furthermore, we still can’t guarantee that long term sustained weight loss is possible. We simply don’t have any gold standard treatment that guarantees long term or sustainable weight loss. In fact, we know that around 95% of people who diet to lose weight will regain it (and more) within 2-5 years. Current evidence also suggests that focusing on weight loss can contribute to food and body preoccupation, weight cycling and weight stigmatisation (Bacon, 2011).
Why the BMI is not an accurate marker of health
The Body Mass Index (BMI) was initially developed by a mathematician, Lamber Quetelet, in 1832, to measure and characterise what was considered the “typical” man. It was then renamed by Ancel Keys in 1972 as the Body Mass Index for the purpose of population studies — not as an individual marker of health. The design and application of the BMI has many flaws, particularly given its original design and intended use.
Importantly, we can’t make assumptions about someone’s health status or body composition from the BMI. Although some studies show that a high BMI is linked to poor health, this suggests a correlation, but not causation. It’s therefore difficult to claim that a high BMI is the cause of poor health outcomes. Someone’s BMI provides no information about diet quality, sleep patterns, stress levels, exercise patterns, trauma history, social connectedness, food insecurity, and housing, or any other determinant of health. The picture it offers is invariably narrow and one-dimensional.
What impact does the weight-centric approach have on health?
The determinants of health are broad and complex, and shouldn’t be limited to nutrition and weight. In fact, weight-centrism can blind us to the importance of other health-related factors, and may even inhibit them, For instance, we know that social connectedness is linked to a decreased risk in all-cause mortality and a range of diseases (Tribole, 2020) — and yet the power of weight stigma can profoundly impact a person’s ability and willingness to maintain fulfilling social relationships.
As mentioned previously, a weight-centric approach increases weight stigma, making it difficult for people with larger bodies to access adequate health care and to be at ease when engaging with health professionals. Christy Harrison comments that “Weight stigma has been shown to pose a greater risk to your health than what you eat.” Labelling people via the BMI or a weight-focused perspective simply isn’t health promoting, and may act as a barrier to the provision of necessary healthcare.
The Butterfly Foundation’s latest research tells us that 4.1 million people in Australia are significantly impacted by body dissatisfaction (2024), which only reinforces the need to consider approaches to health that foster a healthy body image in people. We also know that body dissatisfaction and weight-based discrimination (weight stigma) are linked to an increased risk of:
- stress
- disordered eating
- negative body image
- low-self-esteem
- other mental health conditions such as depression, anxiety (Harrison, 2019)
- weight cycling
In short, focusing on weight and the BMI as the cornerstones of health can actually have the opposite effect.
Let’s consider the experience of someone in a larger body seeking help
Have you ever attended an appointment with a health professional expecting help and advice, only to be told, “You just need to lose weight,” How did you find that? I can only imagine that it would have been a disempowering experience: most people are likely to feel deflated by a health professional’s failure to listen and explore the various treatment options available to them. You are not alone if this has been your experience. Indeed, research tells us that because of such experiences, people are less likely to seek help from a health professional.
Therefore, it seems paramount that instead of just offering weight loss, that we as health professionals start to consider all the health promoting strategies that are available. Shifting to this approach, will help people to feel more at ease to seek help and to consider change.
What does the science say about the weight-neutral approach?
Weight-neutral health strategies are alternative interventions that offer a more holistic approach to health. Unlike weight-centric perspectives, they address psychological and social issues, including the burden of experienced and internalized weight stigma. (Berit, 2024)
Research has shown that the weight-neutral approach (HAES, Intuitive Eating, Non-Diet) is associated with improvements in physiological measures (blood lipids, blood pressure, blood sugar levels), health behaviours (eating and exercise patterns) and psychological outcomes (quality of life, self-esteem and body image) (Bacon, 2011).
Making space for you to express your desire for weight loss
Although I am a non-diet dietitian, I don’t judge people for wanting to pursue weight loss. I hear you and see you. I too was once trapped in the pursuit of shrinking my body. It makes sense that many people diet, given the dominance of diet culture and the valorization of thinness.
Our brains are wired to help us fit in, avoid danger, and seek safety. For many of us, dieting has served precisely that purpose; shrinking our bodies is our attempt to conform, to be accepted, or to feel a sense of belonging. Whether you have or want to pursuit weight loss, for health, acceptance, or as a response to weight stigma, I want you to know you’re not alone. I don’t judge anyone for habouring this desire.
The journey towards a weight neutral approach
The desire for weight loss won’t just disappear overnight. Even though you may be seeking a different approach to health, you might still retain a strong longing to diet or lose weight. And it is something you may wrestle with for some time. This is entirely normal. And I am happy to create space where you can explore this desire whilst learning about the weight neutral approach.
Finally, the weight-neutral approach doesn’t mean we avoid the topic of weight. It may be a part of your story, and you may have questions you want to explore. What it does mean, however, is that discussions around weight will be done with respect, sensitivity, and care.
Please see don’t hesitate to reach out if you would like to learn more about the weight neutral approach.
References
- Bacon L, Aphramor L. Weight science: evaluating the evidence for a paradigm shift. Nutr J. 2011 Jan 24;10:9. doi: 10.1186/1475-2891-10-9. Erratum in: Nutr J. 2011;10:69.
- Berit L Heitmann Debating Weight Loss vs. Weight Neutral Strategies for Improvements of Health Current Obesity Reports (2024) 13:832–842
- Butterfly Foundation (2024). BodyKind Youth Survey:Your body image, Your voice 2024 report. Retrieved from http://www.butterfly.org.au/youthsurveyfindings
- Clifford D, Ozier A, Bundros J, Moore J, Kreiser A, Morris MN. Impact of non-diet approaches on attitudes, behaviors, and health outcomes: a systematic review. J Nutr Educ Behav. 2015 Mar-Apr;47(2):143-55.e1. doi: 10.1016/j.jneb.2014.12.002. PMID: 25754299.
- Holt-Lunstad J. Social connection as a critical factor for mental and physical health: evidence, trends, challenges, and future implications. World Psychiatry. 2024 Oct;23(3):312-332. doi: 10.1002/wps.21224.
- Levinson JA, Clifford D, Laing EM, Harris CL, Slagel N, Squires ND, Hunger JM. Weight-Inclusive Approaches to Nutrition and Dietetics: A Needed Paradigm Shift. J Nutr Educ Behav. 2024 Dec;56(12):923-930.
- Mauldin K, May M, Clifford D. The consequences of a weight-centric approach to healthcare: A case for a paradigm shift in how clinicians address body weight. Nutr Clin Pract. 2022 Dec;37(6):1291-1306. doi: 10.1002/ncp.10885. Epub 2022 Jul 12.
- Tribole, E., & Resch, E. (2020). Intuitive eating: a revolutionary anti-diet approach. 4th edition. St. Martin’s Essentials.
- Tylka TL, Annunziato RA, Burgard D, Daníelsdóttir S, Shuman E, Davis C, Calogero RM. The weight-inclusive versus weight-normative approach to health: evaluating the evidence for prioritizing well-being over weight loss. J Obes. 2014; 2014:983495.
