Why We Need a Paradigm Shift from Weight-Centric to Weight-Neutral

This paper by Linda Bacon (their name is now Lindo Bacon) and Lucy Aphramor is a great summary of why we need to change from “watching people’s weight” to doing things that actually improve their health.

First, some important clarifications

• The authors accept that BMI is an inaccurate measure of health and the categories make it seem that people with certain bodies are that way because of some fault of their own and are more likely to in bad health.
• Using the terms “overweight” and “obese” are only used because this is how people currently understand the differences between bodies.
• We recognise that “normal” weight doesn’t mean that this is an optimal for health.
• Also, the term “overweight” falsely implies a weight over which one is unhealthy.
• The origin on the word “obese” mistakenly implies that a large appetite (or greed) is the cause.
• Health at Every Size/HAES is a pending trademark for the association for Size Diversity and Health.

Introduction

• The concepts of being “overweight” or “obese” are based on flawed science because there is no evidence that being “overweight” or “obese” causes health problems.
• We don’t know if losing weight actually brings about any health gains because people can’t maintain the weight loss for any length of time for this to be studied.
• When people lose weight, it is temporary and weight cycling is detrimental to the physical and mental health.
• When people are focused on losing weight, they are distracted (and stressed) and so not paying attention to the things that influence health.
• People who are trying to lose weight get pre-occupied with food and body.
• People who are trying to lose weight have reduced self-esteem.
• People who are trying to lose weight are more likely to end up with and eating disorder or exercise disorder.
• Being weight-focussed leads to stigmatization (weight stigma) and they are discriminated against.
• “Health at Every Size” (HAES) is a movement born out of this concern and questioning the use of weight loss and dieting behaviour for it to be replaced by having goals that don’t involve weight loss. Goals like these are called “weight-neutral” goals. HAES is a weight-neutral approach.

The HAES Science

• Research focussing on a weight-neutral approach to health show physiological improvements such as in blood pressure, blood lipids (cholesterol and triglycerides); health behaviours (eating and activity habits, dietary quality; and psychological outcomes (such as self-esteem and body image).
• HAES is more successful than weight loss treatment and does not have the negative health consequences of weight loss treatment.

Health at Every Size in a nutshell:

Shifting the paradigm from weight to health (genuinely doing this and not using health and weight as interchangeable).

1. HAES encourages body acceptance as opposed to weight loss or weight maintenance because people can’t maintain weight loss and being shamed and not accepting their body is more detrimental to health;
2. HAES supports reliance on international internal regulatory processes, such as hunger and satiety. The reasons why people can’t tune into their hunger and satiety are to do with the psychological “noise” of the mind and the physical “noise” of the body a person experiences when they have been taught to think consciously about eating and therefore lose the ability of the body to stop them overeating.
3. HAES supports active embodiment (choosing to do any kind of bodily movement you can because of how it makes you feel) as opposed to encouraging structured exercise.

The Diet Industry’s Tax Money

• Why do we need a billion pound “diet industry” if the governments weight loss strategies will solve all the health issues we have.
• Have governments got themselves stuck relying on the tax income from the diet industry and are now funding diet industry biased reach to try and prove being fat is the cause of health issues.

Erroneous Assumptions

• The following are erroneous assumptions that we do not question but should because the science just does not add up:
• Erroneous Assumption 1: Being fat will kill you.
• Erroneous Assumption 2: Being fat will make you ill.
• Erroneous Assumption 3: If you lose weight, you will live longer.
• Erroneous Assumption 4: Weight loss is simply a matter of willpower.
• Erroneous Assumption 5: Weight loss can only be a good thing.
• Erroneous Assumption 6: Anyone who is “overweight” or “obese” must lose weight to improve their health.
• Erroneous Assumption 7: People being “obese” is a costing countries enormous amounts of money and the only solution is to treat obesity and prevent it.

Public Health Ethics

• What the government advises people do to is subject to much more scrutiny these days.
• Governments must find the true causes of bad health even if they are not aa simplistic a solution as telling people that it’s their own fault and that they should lose weight.
• The real solutions are much more difficult to solve and are governments’ owns doing, like some people being in worse health because they are poor.

Clinical Ethics

• The medical profession needs to sort this out because using weight as a goal does not work.
• But more than that, weight loss is harmful to health and the act of trying to lose weight is the reason many people ended up being “overweight or “obese” in the first place.

What All This Means

• Weight is not an acceptable target for people to use.
• HAES (weight-neutral approach) should be used as the target.
• Governments should put more money into research to show that weight-focus causes harm to people and into the HAES approach.
• HAES propose guidelines to help people become weight-neutral,

e.g. “health promotion” and not to use stigmatising language like “overweight” and “obesity.”

e.g. addressing real causes of health differences due to being poor.

e.g. taking into consideration the whole person not just how they look.

e.g. considering the effects the genetics and stress have on health also.

e.g. practitioners should learn what causes people to be in larger bodies i.e. it is not lack of willpower.

e.g. focus only on changing modifiable behaviours i.e. not weight (or eating as eating is an instinct and not a behaviour – Alison Hall)

e.g. governments should learn how people experience their interventions.

You can read the full article here

Weight Science: Evaluating the Evidence for a Paradigm Shift  Nutr J 10, 9 (2011). Bacon, L., Aphramor, L.

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