The Non-Diet Approach is the clinical application of the Health at Every Size (R) values. Weight-neutral approaches such as the Non-Diet Approach have resulted in decreased body dissatisfaction, decreased disordered eating and decreased depression and lead to increased sustainable, enjoyable self-care behaviours such as eating and moving well in the long term. The Non-Diet Approach and the Non-Diet Approach model as described here were developed as part of Fiona Willer's PhD research into weight-neutral approaches in nutrition and dietetics counselling for people with weight concern.
Prescribing diets is not the answer.....
These days weight, and what to do about it, is highly controversial. Fatness is now assumed by many to be an unequivocal marker of health status. There is also the pervasive assumption not only that weight itself is the problem, but also that dieting is the answer. Dieting for weight loss and preoccupation with body shape and size is a highly culturalised phenomenon which is so widespread that it has become normative in western society. It is so deeply entrenched that alternatives to weight loss dieting and studies which show a protective effect of fatness are often met with undue scepticism and sometimes outright outrage. Not only has the damaging effect of excess weight often been (sometimes hysterically) overstated, but there is scant long-term evidence that traditional weight loss interventions achieve what they set out to achieve. As an added blow, these interventions have been shown, where investigated, to lead to exacerbated problems with body image, depression, disordered eating and weight regain for most by five years. Restrictive dieting for weight loss is ineffective in the long term for 95% of people. Some dietitians and psychologists, although well-meaning and highly trained, may be contributing to the problem.
Health, Not Diets aims to support health professionals, particularly dietitians and those in the counselling professions to learn about and start using the non-diet approach with their patients and clients.
People who diet restrictively tend to have concrete beliefs about the value of different foods, eating behaviours and body shape that are more extreme than non-dieters. Frequent weight loss dieting has been associated with increased morbidity and mortality risk, reduced bone mass (even in obese populations) and increased cortisol production, and is a strong predictor of weight gain over time. Further, chronic dieters are more likely to have lowered body appearance evaluation and body satisfaction, exaggerated responsiveness to nutritional or food-related cues, depression and anxiety. People are considered to have Chronic Dieting Syndrome when the following are manifest: a) persistent over-concern with body weight and shape, b) restriction of food choices for two years or more, and c) continual dieting to achieve weight loss without success or with weight regain. Chronic Dieting Syndrome occurs far more frequently in women than men and although the prevalence of Chronic Dieting Syndrome has not been quantified in the literature, it is encountered often in dietetic private practice. It is apparent that the practice of dieting for the vast majority of people with weight concern is unhelpful.
Dietitians are very good at assessing the ‘who’, ‘what’ and ‘when’ parts of individual health improvement through nutrition. We use empirical research to understand what elements are effective in reaching this goal. The non-diet approach is an alternative answer to the question of ‘how’ this knowledge is best passed on to our patients and clients.
In non-diet approaches, the typical dieting behaviours of weighing and measuring food and body, recording detailed food diaries, extensive forward planning and timing of meals, concrete energy intake, specific weight loss goals and the use of ‘diet’ foods are firmly discouraged. It is instead a much more experiential approach, allowing the client to build skills and confidence in their own innate ability to select appropriate foods for their body in appropriate amounts. This behaviour change is underpinned by Self Determination Theory, fostering autonomous self-regulation.
There is a common belief among both health professionals and the general public that abandoning food and eating restrictions will result in food choices of poor nutritional quality, excessive energy intake and commensurate weight gain, and then assumed increased risk of chronic conditions which will further burden the health care system. This is the main criticism of weight neutral dietetics despite the widely researched and consistently poor success of traditional weight loss interventions. Most non-diet approach interventions have shown positive outcomes in physiological and psychological outcomes and BMI tends to remain relatively stable or decreases during and after treatment. Compared with the almost certain weight regain as a result of chronic dieting, this is a major benefit.