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The problem with weight control

These days weight, and what to do about it, is highly controversial. For a long time, fatness has been 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 intentional weight control is the answer. These (unfounded) beliefs continue to exacerbate weight stigma and discrimination. 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 appallingly) 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 health professionals, although well-meaning and highly trained, may be contributing to the problem. 

 No matter how committed someone is to attaining a lower weight, it's unlikely to be the long term outcome they experience.

Despite the overwhelming evidence of the ineffectiveness of intentional weight loss efforts, and complex, multifactorial pathways to higher body weight, the weight loss industry remains strong. In recent years, pharmaceutical companies have made moves to have a BMI of 30 or higher designated as an independent 'disease' state. To do this they have spent incalculable amounts of money to sway public, medical and political sentiment towards thinking of a higher body weight as a medical problem looking for an effective treatment. They fund researchers to write about higher body weight as a 'chronic, relapsing disease', an 'epidemic' and 'the chronic disease of obesity'.  They created World Obesity Day to keep it on the political calendar. They fund political lobbyists across the world to push governments to perceive 'Obesity' strategies as substitutes for actual public health. They establish 'Obesity' organisations in multiple sectors, with some catering to health professionals and others to the public - all with the intention of swaying public sentiment about body weight to something people might ask their doctors for treatment for, and their government to fund treatment for.  They even position themselves as weight stigma experts, without ever acknowledging their own central role in perpetuating weight stigma by medicalising and pathologising body size.  

A better alternative: Weight Inclusive, weight neutral care

Weight-neutral approaches in healthcare are those that do not aim to change body weight, nor have the reliable outcome of body weight change. The Health at Every Size (R) Principles provide a robust conceptual framework for ethical, health-enhancing, evidence-based healthcare, especially for larger-bodied people who are often the recipients of stigma and discrimination, including in healthcare.  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.  

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.

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 beyond the end of the intervention program. 

The non-diet approach methods detailed in The Non-Diet Approach Guidebook for Dietitians (2013) were brought together by Dr Fiona Willer (Advanced Accredited Practising Dietitian, PhD) and academic in Nutrition and Dietetics as part of her PhD study into the use of Health at Every Size (R) practice by health professionals. In 2014, Fiona collaborated with Louise Adams, clinical psychologist, to develop The Non-Diet Approach Guidebook for Psychologists and Counsellors.

Time for a paradigm shift

Diet Paradigm:

Inflexible, quantitative, prescriptive, rigid, perfection-seeking, good or bad foods, rules, deprivation, time-based, fear-driven, guilt-inducing, shaming, body hatred, hunger, struggle, rationalising, temptation, thought-consuming, punishing.

Non-Diet Paradigm:

Flexible, accepting, welcomes all foods, intuitive, qualitative, supporting, enjoyable, life balance, appreciating, comfort, confidence, variety, freedom, natural, calm, pleasurable, kindness, nurturing, grateful, nourishing, forgiving, satisfaction, trust-building.

Health at Every Size (R) and HAES (R) are Registered Trademarks of The Association for Size Diversity and Health and used with permission.