Size Inclusive Practice for Dietitians:
The Non-Diet Approach
A note on Health at Every Size (HAES):
The terms 'Health at Every Size' and 'HAES' were originated by the Association for Size Diversity and Health (ASDAH) in 2010 and Trademarked in US Territories. ASDAH also created the Health at Every Size (HAES) Principles. The professional use of the HAES Principles was widely encouraged by ASDAH without specific licensing until late 2022 when the ASDAH leadership decided to regain control over their use and provide permission by application only. If you would like to use these terms to describe your work, please apply via www.ASDAH.org and understand that continual professional development using ASDAHs materials is likely to be required.
It is not necessary to label yourself as a HAES provider if you are using a weight inclusive approach. The HAES Principles are one of many weight inclusive frameworks. Be specific in your marketing materials and practice about the specific characteristics of the services you provide, rather than using catch phrases and popular social media hashtags as shortcuts. A detailed approach will ensure that your clients and colleagues understand your offerings more clearly. Connect with other weight inclusive practitioners and peer support groups in your area to ensure your practice remains safe, up-to-date and relevant for the communities and individuals you work with.
The non-diet approach turns traditional dietary prescription on its head by shunning external eating drivers and panic-driven behaviours, and turning the focus inwards, towards internal body cues, self-acceptance and more multidimensional concepts of self-care. This method is showing promising clinical and psychological results as one of the most helpful, least harmful ways to assist those with weight concern. We as dietitians are well-placed to counsel within this paradigm. After all, our professional reason for being is to assist individuals to make helpful food and eating choices which allow them to live as full and healthy a life as possible.
Many health professionals and health advocates have used non-diet concepts but their development has been led by their discipline. Non-diet approach concepts have been used by psychologists, psychotherapists, doctors, dietitian/nutritionists, health coaches, counsellors, nurses, exercise physiologists and lay people. As a result, the following terms are all used to refer to techniques which use a weight neutral approach to weight concern and/or health:
- Intuitive Eating
- Health At Every Size (HAES) (see note below)
- Innate eating
- Eating Competence
- Anti-dieting movement
- Non-diet or non-dieting approach
- Weight-neutral dietetics
- Size inclusive approaches
I prefer to call it weight-neutral dietetics and the non-diet approach because, as dietitians, we are in the business of dietary prescription and it is a more helpful description of the broad counselling approach we would use. Mindful and intuitive eating describe techniques within the non-diet approach; innate eating refers to learning to respond ‘biologically’ to normal body cues, another non-diet technique. The incorporation of the Health at Every Size principles compels a weight-neutral approach to also be stigma informed.
Non-diet approach intervention studies to date have focused on exploring the use of this paradigm in group settings but the vast majority of dietetic consultations worldwide still take place one-on–one. Many dietitians have already begun to incorporate mindful eating techniques into their dietary counselling and practising within a size inclusive framework as it becomes clearer that an approach that encourages internal eating autonomy is more psychologically and clinically helpful for people who have a history of weight loss dieting, regardless of their weight history.
Changes to dietary quality are, of course, of particular interest to dietitians. My PhD research showed that those who focused on achieving and maintaining healthy habits in a weight neutral way had better dietary quality scores than those who were trying to reach a weight loss goal, even if they were using 'healthy habits' to try to lose it. Non-dieters also had a much lower likelihood of dangerous eating practices, disordered eating and eating disorders and far better psychological metrics, especially self-compassion and body appreciation. If eating for health is a goal for your clients, a size-accepting weight inclusive approach is much more likely to achieve higher dietary quality and a healthy, adaptive eating style. You can read my whole PhD thesis here: A Good Fit: Health-Oriented Size Acceptance and Australian Dietetic Practice (2021) https://eprints.qut.edu.au/211444/
Want a guide to how to apply the non-diet approach in your practice?
The non-diet approach is relatively new to dietetics and many dietitians express concerns about the specifics of how to administer this approach in practice. Given that many techniques used in non-diet therapy were developed in the discipline of psychology, it is important that the techniques used in dietetic counselling sit within our scope of practice.
Up until now there has not been a practical guidebook or training specifically for dietitians to bring together the non-diet approach elements.
My book, The Non-Diet Approach Guidebook for Dietitians, takes the common threads from current non-diet approach research and practice and looks at them through a dietetic lens. In other words, this guidebook includes the techniques within the scope of practice of dietitians, and excludes some elements of other protocols which lie outside of the typical dietitians practice skills. Please see the precis in the Resources section of this website for more details about the guidebook. If you would like to purchase a copy, you can do so here.
This book (as an ebook) is included in the Non-Diet Approach for Dietitians online course.