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.
Updated 2/3/2023
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I do this work full time and a lot what I do, like answering emails, giving talks to groups who can’t afford to pay, etc. is unpaid, so I created a membership program so that people who like my work and feel they get value out of it and/or who just want to support the work that I do can become members for ten bucks a month Membership includes free attendance at my monthly online workshops, a paid-level subscription to my Weight and Healthcare newsletter and more. Learn more here!
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The regular e-mail blog subscription (available at the top right hand side of this page) is always completely free. If you’re curious or uncomfortable about any of this, you might want to check out this post. Thanks for reading! ~Ragen
Dances With Fat 
And then the people around you assume your healthy habits are about weight loss.
-No chocolate, thanks. (It doesn’t agree with me.)
-Right, you’re on a diet.
-No, I’m not.
-But if you’re on a diet, why are you eating those tortilla chips?
-Because I’m not on a diet, they’re the only whole grain in sight and work better for me than all that white bread, and why shouldn’t I eat them? You’re eating them.
-But I don’t have to diet.
-Neither do I.
(OK – that’s a composite – I’ve never had all that in one conversation – but I’ve had all those conversations with one person…)
Yeah, it is funny to confuse people by eating something seen as healthy at one moment, and something seen as indulgent at a different moment. Some of them have real trouble parsing it.
This is such a great post, thanks Ragen. I’m trying to start an aquatic fitspo tumblr that is based on HAES and size acceptance since there are so few, and the few that exist tend to devolve into thinspo/pro-ana blogs. This post will really help me keep myself in check when I start posting regularly–I’m still getting over my own insecurities and biases; it’s very tough to de-brainwash yourself!
Thank you for this post.
I love: “This is a lifelong journey and there is no right or wrong , there are just experiences and what you’re going to try next.” This is an approach I like to follow as well.
Once I started seeing my life as a series of experiences, I could then formulate “experiments” to elicit a new set of experiences. Some I completely enjoyed and enjoy to this day (sailing, gardening, traveling and living in Africa). Some I can now say that I will pass on (yoga, living in cold climates, coconut milk). The important thing for me is that I “experience” life’s journey. Bring it on!
This post is especially wonderful. This is where I am right now.. working at giving up the self-hate and frustration of weight focused actions and turning towards health positive behaviors. I’ve got a long way to go, but I’m headed the right direction. Trying to make sure I do not continue to send weight-biased messages in my own interactions with others.
Today was my first visit to my doctor since discovering this website. The nurse asked me to step on the scale, and when I said I’d prefer not to, she told me I had to and that I could stand backwards and not look at the number if I preferred (which clearly wouldn’t have mattered because of what followed), then took my blood pressure. When the doctor came in to see me, she told me she was worried about my weight. I tried to stand up for myself and tell her that my weight has been stable for the past 6 months and that I’ve finally stopped wanting to die because of being overweight. She told me to join Weight Watchers and referred me to a shrink (apparently after being told dieting makes me suicidal, the prescribed treatment is CBT and more dieting!). I told her Weight Watchers defines success as a 5% weight loss and that people who yo-yo diet are counted as successes multiple times. She told me they’d tell me new things about nutrition I had never learned before and that it works because she knows people who do it. I don’t understand why she would prescribe a “life style change” after I told her I finally stopped wanting to die.
She told me I have high blood pressure (120/86 – it’s usually more like 110/60 but I was nervous about the upcoming conversation) and that I was going to be sicker as an obese person than a thin one (VFHT), and when I told her I’m probably going to get diabetes anyways because my dad and both my maternal grandparents were diabetic, she told me it was easier to manage diabetes at 150 lbs than 250 lbs. I told her most people regain weight after they attempt weight loss and I was scared that I would just end up at a higher weight. She responded that she wanted to test my thyroid and handed me a slip of paper. I pointed out that she had checked off tests for diabetes and cholesterol too, and she told me I could throw the paper out if I wanted to. So apparently if I want a thyroid test, I have to have the other tests too. And I know if I have even one number into the “undesirable” range, she’s going to point at that and tell me I’m unhealthy.
I would start looking for a new health care provider. I believe HAES has some resources, see their page at: http://www.lindabacon.org/HAESbook/excerpts.html
You may be interested specifically in: http://lindabacon.org/HAESbook/pdf_files/HAES_Providing%20Sensitive%20Care.pdf
Well, I’m in a small town in Canada where people get removed from their family doctor’s patient lists if they don’t visit after a few years – this happened to my sister 3 years ago and she’s still on a waiting list for a new family doctor. I do have access to free clinics that offer same day appointments though – maybe doctors who are less familiar with me won’t sit and lecture me for 45 minutes while I cry my eyes out.
I plan on taking some of the peer-reviewed studies Ragen has linked to my next doctors visit. Not that my doctor is bad – she’s been very supportive of whatever goals I set for myself. But I think it would be a good way to start opening up the eyes of medical staff if I can show them the research that supports my claims.
Thank you Ragen for providing this website! (first time comment here, but I’ve been reading for a few months now.)
Hi Melissa,
Thanks, I’m glad that I could help. I’d love to know how it goes with your doctor 🙂
~Ragen
I took a print out of the studies in the “For Fat People and Their Doctors”, but my doctor dismissed them saying “you can find evidence online to back up any position. I told her I want to believe her that weight loss can work, and I just need to see ONE study where more than 5% of people were able to keep weight off for longer than 5 years, and she said “that wouldn’t exist. No one would fund it” and dismissed the idea of having proof that weight loss works. She also told me even if the studies about overweight and obese people with healthy behaviours being just as healthy as other people, that it doesn’t matter for me because they would have taken a BMI close to 30 for the obese people and because I’m much higher than that I can’t know what the data would be for people my size – and in that, there is a kernel of truth that is freaking me out and I’m starting to panick about my weight again. I wish when she brought up weight loss I had just said ok abd bugged out.
“That wouldn’t exist. No one would fund it”?! I seriously, seriously beg to differ. Weight Watchers would LOVE to fund a study showing that weight loss can work. A thousand other people would, too. Not to mention that it’s not that hard to get funding for health studies from NSF, NIH, etc. I will be the first to admit that I don’t know much about weight loss myself, as I inherited my dad’s Cherokee metabolism rather than my mom’s European, which is why all my sisters have diabetes and I don’t (for which I’m *extremely* thankful, but the fact that I look slender is irrelevant to my life – I enjoy being athletic, but I’ve never cared how other people look at me as long as those I love enjoy the view. 🙂 But research – that I know about. That’s my profession. I have a certification as an IRB Professional (CIP). I have spent nearly eleven years now in the human subject research field. I can guarantee that a weight loss study could get funded…it might not get much fanfare after the results show negatively, of course…
I’ll admit, though, that I could never do Regan’s job. I have NO patience with trying to convince the idiots that comprise the majority of the population to use their brains for anything. I would never bother to try and educate a doctor on anything, either, unless I already knew that the person was actually willing to listen to me. I know firsthand that most doctors (and believe me, I cherish the few exceptions I’ve found over the years) don’t bother to listen to anything a patient has to say – they are the ones who spent all that time and money on medical school, after all, and if you were capable of understanding the intricacies of the human body, you would have done so, too. Since you don’t have a degree, you don’t have a brain, so they don’t have to listen to you. I am extremely thankful that when I moved here five years ago, the first doctor I saw at the University health clinic turned out to be brilliant and open-minded. She’s been *great*. (Now if I could just find a similarly fabulous doctor for my husband and kids, since only employees and students can use the Uni clinic.)
I’m sorry you had to go through that – no one should have to! Please check out the resources above (as well as the others on the main HAES page) – who knows? You might change some minds. Meanwhile, I’m glad you found this site!
Thanks, Regan! This is exactly what I needed. I’ve been gradually trying to get Vicki & Chris to stop using weight as a goal in their conversations with me (I got Chris to stop being unthinkingly racist by the same tactic – I just pointed it out every time he made a racial comment that it was either unsupported or actually a comment about culture, not skin culture, and he gradually learned to change the way he thought and spoke) but while Chris isn’t actively trying to lose weight, so it’s easier to get him to think in terms of health, Vicki has been over 300 pounds for so long and unhealthy in both mind and body, that it’s going to take a stronger, sit-down, read this, discuss this, explain this type of approach to get her to even see why her obsession with her weight is not only not helpful, but actively hurting her.
So I’m compiling a list of your posts that each have what I need – this one, of course, “For Fat Patients and Their Doctors” for the research compilation, and “Do 95 Percent of Dieters Really Fail” for a GOOD discussion on why she should stop obsessing about scale numbers.
Dear Rasen,
If you haven’t saved my life, you’ve made the next decade much happier. I stumbled across your blog and the scales have fallen from my eyes. I’ve been struggling and panicking about continual weight gain as I age. I’m only 41. Been trying and failing with diets for the last decade and wondering what happened to how I used to feel about my body which was just fine.
I can finally see the fat shaming going on and realise that the real problems with my weight, the ones that really are a problem, are related to fitness rather than weight.
I’ve resolved to stop, starting today. Stop with the fitspo. Stop the idea of what I must weigh. Stop treating myself badly. It’s going to be a bit tricky but it feels a relief.
And your dancing is beautiful. Reminded me of what I actually want for myself.
All good wishes
Sarah
Hi Sarah,
I’m so glad that you are finding a better path for yourself and I’m thrilled and honored to have the chance to support you. If there is anything that I can do to help, please feel free to e-mail me at ragen at danceswithfat dot org! Best of luck and big fat hugs to you!
~Ragen