I’m a Weight Inclusive Non-Diet Dietitian

“Health professionals aren’t gods. They are human beings who received their training in a certain cultural context…that context is fat phobic and food-phobic. That’s worth keeping in mind whenever you talk with a healthcare provider. They may have advanced degrees and valuable knowledge in many areas, but unless they’ve done the work to unlearn diet-culture beliefs, odds are their ideas about food, movement, and body size will be steeped in weight stigma and “good/bad” food rhetoric – which can do a lot more harm than good to their client’s health,” – Anti-Diet page 241, Christy Harrison MPH, RD

It bothers me that we have a harmful diet culture to begin with, but what bothers me even more is how I contributed to it for years until I actually took the time to learn about the harms of dieting, weight stigma, fat phobia, and the true health and healing that happens through the frameworks of Intuitive Eating, Health at Every Size® and a weight inclusive approach. Read on to hear my evolution as a human and practitioner. I can almost guarantee you’ll either relate to it, find peace in it, or get annoyed like I did along the way.

Maybe you grew up hearing your Mom comment about her rolls and belly in self-deprecating ways followed by on and off diets of cabbage soup, Weight Watchers and the like. Maybe you learned when you were 4 or 5 years old that some foods are “bad”, and some foods are “good”. Maybe you have a family member in a large body or you yourself are in a large body and you constantly get bullied about your (or their) body size and what you (or they) choose to eat. Maybe you get the courage to go to an exercise class and all they talk about is working off the brownies or pizza or whatever food you may “overindulge” in this weekend.

Maybe you’re in a larger body and have back pain or sleep problems and you go to the doctor only to hear “lose weight” as the solution, which you’ve been trying to do for the past 20 years of your life “unsuccessfully”. You leave the doctor feeling hopeless with no solution for your back pain with a side of shame, blame and guilt for the size of your body. You choose not to go back to that doctor (or any other) because they don’t take your concerns seriously. You’d rather avoid medical care than be shamed for your weight, understandably¹.

Maybe you fear, hate, despise, and mistrust your body because that’s what the world tells you is truth. Maybe you don’t see any messages in the media that look like your body, so you think there’s something wrong with you. Maybe you live in a smaller body and you see how the world treats people in larger bodies so you’re afraid of weight gain.

I can relate. I went to school to be a dietitian to “prevent people from living in larger bodies” because I grew up with a family member in a larger body. I perpetuated the aforementioned ways of thinking about food, bodies and health for years. Gave meal plans, calorie counts, weighed clients, focused on weight loss as the ultimate goal despite the unhealthy behaviors it took to get there (even though they are often congratulated by the medical community). Although I had more of a “holistic” view than many others, I still perpetuated weight stigma and obsession in this way.

Clients would skip birthday parties because they couldn’t trust themselves around cake. They’d say no to life over and over, being held back by their food and weight worries. They’d cry in our sessions because they felt like a failure wondering why couldn’t they just “get it” aka lose weight. With every scale experience or calorie count they got further away from actually learning how to care for themselves. The interventions would get extreme – weight loss surgery to staple their stomachs, or every morsel of food tracked and weighed. Disordered eating and the development of eating disorders were common side effects of this weight obsessive focus.

Something else that really speaks to our society’s issues with food and weight is how many smaller bodied people want to lose weight as well. Our cultural fat phobia is so much deeper than worrying about “health” or larger sized bodies. It became clear to me how our toxic fear of fat had gotten so out of control that even people with “culturally acceptable” body sizes are deeply affected by the harmful effects of our diet culture and weight obsession. Dieting and the pursuit of intentional weight loss inherently increases your risk of an eating disorder.

I knew it wasn’t working but my entire medical and nutrition community (and world) was telling me this is the right way. My gut feeling kept screaming at me “this is not the right way, Lexy,” But still, I didn’t change perspectives overnight.

I heard there was another way but that it was going to take a ton of “undoing” and “unlearning” to even begin to understand it because of the toxic food and body image culture I had grown up in.

I heard of Intuitive Eating and Health at Every Size® through a friend. I was honestly outraged. I called all my RD friends who were also outraged and we complained and moaned about how on earth could these health professionals be touting something SO clearly unhealthy. We can’t eat donuts! No way. Listen to your hunger and fullness? People don’t know how to do that – that’s why they need us to tell them how much to eat and when! It felt so wrong. Healthy at every size? No – fat is to be feared and avoided at all costs (or so I thought). How could you be healthy in a larger body?

No matter how upset it made me, it was that feeling like once you know something you can’t unknow it. I stayed here for about a year. Just quietly watching lots of RD friends around me adopt this mentality and silently fearing for them and their clients.

Eventually I got curious and began researching Intuitive Eating, Health at Every Size®, and weight inclusivity. I was shocked by what I found the more I learned. It actually made sense. I started thinking about how the weight loss focus I had before with clients never worked and how frustrated we all were with it. I really started to understand the harm I had done for years allowing people to fall victim to the belief that they needed to shrink their bodies to be healthy, or worthy – and that I had a healthy way to help them do it – false. I felt such guilt. That guilt fueled me in my passion for this new way of defining health and happiness.

I didn’t get it overnight. I’m not someone who just easily conforms to things. I’ve been a vegetarian since I was 4, I’m an Aquarius, and was raised to always remain teachable but to ask tough questions, dig deep and follow my gut. It took a LOT of books, therapy, professional supervision, RD mentoring, and working through my own sh*t around body image, weight stigma, and food fears.

I am so thankful for the amazing people who held space for me to grow in this area without shame, blame or judgement. I emerged from this process with a newfound passion and sense of what health really means and how to ACTUALLY help people achieve it. I also realized that what made life so uncomfortable for my family member in a larger body was not their weight. It was how uncomfortable our society makes life for those in larger bodies. Bodies don’t need to change, our culture does.

The research supports it on all angles. Studies show long term weight loss is not only not sustainable, but harmful to our bodies; that larger bodies do not mean unhealthy bodies; that Intuitive Eating results in healthier relationships with food as well as physiological improvements². But more importantly than the research, is that I’ve personally lived through it. Learning from my pitfalls and a shit ton of experience I have seen the drastic differences between a weight inclusive and weight normative approach. When people ask, why don’t you “do” weight loss – here’s why.

Issues with the weight “normative” approach aka a focus on weight loss:

#1 The research doesn’t actually support the fear of fat…

Despite the widely held belief that a higher body weight causes poor health, data do not support this³.Other factors such as exercise, nutrition, insulin resistance and weight stigma often partially or fully explain links between weight and health, and we see health being achieved at ALL body sizes, not just smaller bodies. Some studies even show a preventative effect of higher body weights.

#2 It’s not sustainable…

Weight loss initiatives have NOT been shown to even work.⁴ It has been estimated that no more than 20% of people who complete weight-based interventions maintain their weight loss one year later. Analysis of 29 studies on weight-loss programs showed that participants regained 77% of their lost weight on average after 5 years. That’s less than ¼ or a 23% success rate.

#3 Weight ups and downs are not good for the body…

When comparing weight fluctuations to weight stability (even at higher weights), studies show a connection between weight cycling (repeated periods of weight loss and regain) to loss of muscle tissue, chronic inflammation, and metabolic disturbances⁴. In other words, our bodies do not respond well to continued fluctuations in weight, it’s often better to stay the same weight and focus on health behaviors instead of weight loss.

#4 Intentional weight loss increases the risk of eating disorders…

Weight suppression, food restriction and dieting have been associated with the onset and maintenance of eating disorders and disordered eating.⁴ A culture and society that continue to praise intentional weight loss and achieving a severely unrealistic “thin ideal” supports behaviors related to eating disorders and disordered eating.

As a Registered and Licensed Dietitian, I have a moral and professional obligation to provide EVIDENCE based care to my clients. As you can see, the evidence does not support a weight normative approach. After I learned about the reality of weight science and weight stigma, my approach toward counseling changed. Instead of focusing on weight as an outcome (weight normative care), my practice is entirely weight inclusive.

Weight inclusive in essence means we help you learn how to take care of your body without trying to shrink it…

We DO:

• Foster health behavior patterns that promote well-being, regardless of body size
• Encourage self-care practices
• Encourage a positive view of the body
• Appreciate that bodies naturally come in a variety of shapes and sizes, and ensure optimal health and well-being is provided to everyone, regardless of their weight
• Given that health is multidimensional, maintain a holistic focus (i.e., examine a number of behavioral and modifiable health indices rather than a predominant focus on weight/weight loss).
• Create healthful, individualized practices and environments that are sustainable (e.g., regular pleasurable exercise, regular intake of foods high in nutrients, adequate sleep and rest, adequate hydration)

We support a weight inclusive environment by supporting Health at Every Size® principles:

1. Weight Inclusivity: Accept and respect the inherent diversity of body shapes and sizes and reject the idealizing (praising, regard as perfect) or pathologizing (treat as unhealthy) of specific weights.
2. Health Enhancement: Support personal practices that improve well-being, including attention to individual physical, economic, social, spiritual, emotional, and other needs.
3. Respectful Care: Acknowledge our biases, and work to end weight discrimination, weight stigma, and weight bias in ourselves.
4. Eating for Well-being: Promote flexible, individualized eating based on hunger, satiety, nutritional needs, and pleasure, rather than any externally regulated eating plan focused on weight control.
5. Life-Enhancing Movement: Support physical activities that allow people of all sizes, abilities, and interests to engage in enjoyable movement, to the degree that they choose.

But does it work? Is it healthy? Yes:

“Data from randomized controlled trials have upheld the efficacy of programs with a weight-inclusive emphasis, such as HAES. Specifically, participants following the HAES model achieved statistically and clinically significant improvements in physiological measures (e.g., blood pressure), behavioral practices (e.g., increased physical activity, decreased binge eating), and psychological measures (e.g., increased self-esteem, decreased depressive symptoms) and did not demonstrate any adverse outcomes, despite the fact that weight remained relatively unchanged,”⁴

Through Intuitive Eating (created by Evelyn Tribole and Elyse Resch) we provide a framework of developing a healthier relationship with food. The 10 principles of Intuitive Eating are:

1. Reject the Diet Mentality
2. Honor Your Hunger
3. Make Peace with Food
4. Challenge the Food Police
5. Discover the Satisfaction Factor
6. Feel Your Fullness
7. Cope with Your Emotions with Kindness
8. Respect Your Body
9. Movement – Feel the Difference
10. Honor Your Health – Gentle Nutrition

Benefits of Intuitive Eating:

“Improvements in eating habits, lifestyle, and body image as measured by dietary restraint, restrictive dieting, physical activity, body satisfaction, and drive for thinness. Participants also experienced improved psychological health as measured by depression, ineffectiveness, anxiety, self-esteem, negative affect, and quality of life. Several improvements were sustained through follow-up periods as long as 2 years. Completion rates were as high as 92% in nondieting groups. In addition, improvements in eating behaviors and maintaining a nondiet approach, increased self-esteem, and decreased body dissatisfaction were sustained long-term. Overall, studies that encourage individuals to eat intuitively help participants abandon unhealthy weight control behaviors, improve metabolic fitness, increase body satisfaction, and improve psychological distress,”²

“Research has shown that intuitive eaters who don’t have any ‘off-limits’ foods or follow any diet-culture rules, have better health outcomes on an impressive array of measures: lower cardiovascular risk, decreased triglyceride levels, more-favorable levels of HDL cholesterol, lower rates of disordered eating, less likelihood of feeling out of control with food, less food-related anxiety, less internalization of the thin ideal, lower levels of body dissatisfaction and shame, greater enjoyment of food, increased body appreciation, less self-silencing behavior, higher sensitivity to their own internal states, higher levels of self-compassion, greater life satisfaction, more proactive coping skills, and better self-esteem,” Anti-Diet page 224, Christy Harrison MPH, RD study referenced is here.⁵

If you’re on a path of pursuing intentional weight loss that is absolutely understandable and I do not shame, blame, or judge you for that whatsoever. I am NOT anti weight loss in general. If what you’re doing is working for you, great! But if you identified with the experience of feeling ashamed of your body, thought you “failed” weight loss or have felt like there was no other path to health and happiness than to shrink your body or stay small, I promise you there is.

With a weight inclusive, non-diet approach you may lose weight, you may stay the same, you may gain weight – the point is that we don’t focus on intentional weight loss as our intended outcome. We focus on putting health behaviors FIRST, and whatever happens with weight is what your body is meant to be at.

If you’re interested in another way and are willing to put weight on the back burner (or side burner, or wherever that’s not in the front) and learn how to prioritize health behaviors regardless of weight, then I’m your girl. We’ll work collaboratively to identify current behavior and thought patterns around health and wellness that aren’t serving you, and work towards developing new patterns that promote true healing from the inside out so you can feel your best and live your best life. Wellness without obsession IS possible, and I’m all for it. Book a free intro call with me here. 

Studies referenced:

1 Healthcare Avoidance at Higher Weight

2 Evidence for Intuitive Eating 

3 Why Weight Doesn’t Equal Health

4 Weight Inclusive Versus Weight Normative Approach to Health

5 Health Benefits of Intuitive Eating

Recommended books:

Body Respect – Linda Bacon, PhD and Lucy Aphramor PhD, RD

Health at Every Size: the Surprising Truth About Your Weight – Linda Bacon, PhD

Intuitive Eating – Evelyn Tribole MS, RD, AND and Elyse Resch MS, RD, FADA, CEDRD

Anti-Diet – Christy Harrison MPH, RD

Body Kindness – Rebecca Scritchfield RDN