I got a question from reader Iroshi asking how to discuss the transition from a weight centered approach to health to a Weight Neutral approach. I’ll absolutely give my opinion about that but first let’s take it all the way back and discuss why someone might want to do that in the first place.
In a weight centered approach body size is used as a proxy for health – assuming that a thinner body will be a healthier body and so if someone is above what is considered a “healthy” weight, weight loss is advised to increase health. There are several issues with this:
- Weight is correlated with some diseases, but weight is not causally related. Thin people get the same health issues as fat people and so using weight as a proxy for health instead of using the simple tests for actual health means that people are either misdiagnosed or undiagnosed. I once had a doctor try to prescribe blood pressure medication before taking my blood pressure (which happened to be normal). I have a friend who was begging to be tested for Type 2 Diabetes (which it turns out that she has) but her doctor told her that it was impossible for a thin person to get T2D.
- It gives fat people the incorrect message that their health supporting behaviors won’t make them healthy unless they make them thin. That is not what the evidence like Matheson et. al, Wei et. al. and The Cooper Institute studies tell us. In Matheson et. al. for example, fat people who practiced healthy habits had the same hazard ratio as thin people who practiced healthy habits and a dramatically better hazard ratio than thin people who didn’t practice healthy habits.
- There is no study that shows that people who lose weight have better long term health outcomes that those who stay fat but practice healthy habits, or those who were never fat.
- Even if there was proof that weight loss makes us healthier, there is not a single study that shows that weight loss is possible for most people long term. The vast majority of people regain their weight within five years and many gain back more than they lost, even if they keep up their diet habits. (Increasingly the evidence shows that the body has a multitude of mechanisms that are designed to regain and maintain weight that is lost.) Weight loss fails the vast majority of the time and often has the exact opposite of the intended effect, and there is no proof that it will make us healthier even if it does work. Weight loss simply does not meet the criteria for evidence-based medicine.
A prescription of weight loss suggests that we do something that nobody has proven is possible for a reason that nobody has proven is valid, and for which failure is a near statistical certainty.
Weight-neutral health a paradigm that acknowledges that health is not an obligation, barometer of worthiness, or entirely within our control, that the focus should be on systemic change including increasing access and decreasing barriers to health (including experiencing oppression, and that, for individual health, the focus is on supporting health and not manipulating body size, and that health-supporting behaviors are a much better determinant of health than body size. (Weight-neutral health is not to be confused with Size Acceptance, which is a civil rights movement that asserts that people of every size deserve to be treated with respect and live free from shame, stigma, oppression, and bullying due to their size). Weight-neutral health acknowledges that health is multidimensional, some aspects of which are within our control and some aspects beyond our control. Health includes genetics, effects of past behaviors, current behaviors, and access to things like healthy foods, safe movement options and affordable evidence-based healthcare. With Weight-Neutral health the individual focus is on practicing healthy habits and allowing your body to settle at whatever weight it settles.
The transition from a weight-centered health practice to a health-centered health practice can be difficult. The problem that I most often hear from people initially is how to set goals. In a weight centered practice the scale is our judge and jury. All eating and movement activities are centered around changing the size and shape of the body. In WNH our activities are focused around nurturing our bodies and giving them their best chance for health. That might include goals for things like sleep, social connection, stress management, movement, and nourishment. It can help to create goals that add rather than restrict (ie: I want to get more/better quality sleep, have more social connection, engage in more movement, drink more water etc.
It should be noted that Weight-Neutral Health is an option, not an obligation, and that health is a very personal thing and so people get to choose how highly to prioritize their health and what path to take to get there and it’s absolutely none of anybody else’s business.
So there are lots of nuts and bolts to work out, and you may want to find a weight-neutral health professional to help with them, but for me the biggest step was deciding to stop hating my body for not approximating a toxic stereotype of beauty, and start appreciating it for everything it is and does. This simple activity did more for my journey to health, happiness and body love than anything else that I’ve done. Once you make the decision to focus on your health and let your weight fall where it may, you’ve taken a huge step toward a weight-neutral approach. After that I think it’s all about trying things. Years ago I was talking to a business consultant friend of mine about how he gets “unstuck” when he’s working with a client and he’s not sure which path to take and he said (quoting someone else, I’m pretty sure:) Try something, anything. If things get better then do more of that, if they get worse try something else.
So on your health journey you’ll try stuff – some things will be spectacular successes (like that time I took up dancing) and some may be spectacular failures (like that time I tried to overcome the fact that I despise distance running) and that’s ok. This is a lifelong journey and there is no right or wrong , there are just experiences and what you’re going to try next.
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