Contrary to the messages we are exposed to from popular culture, media, and public health about body size, focusing on how much a person weighs isn't necessarily an effective way to promote health. These messages play a role in reinforcing what some call “diet culture” and others have called “anti-fat bias.” Diet culture associates weight loss and thinness with health despite mounting evidence of the negative impacts of dieting. Anti-fat bias can persist in workplace, healthcare, and educational settings, threatening both the emotional and physical health of obese or overweight individuals.
Research is showing that weight is not a reliable indicator of an individual's health nor is a weight-centric approach helpful in improving overall well-being. Weight-centric, or weight-normative, approaches emphasize weight, body mass index (BMI), and weight loss as positive indicators of health and well-being. This type of approach values thin body types over others and can have negative consequences such as weight stigmatization, discrimination, and body dissatisfaction; consequences that are associated with weight gain, unhealthy eating behaviors, and depression.
While some weight loss interventions may reduce weight or improve health metrics in the short term, these interventions typically involve other behavioral changes such as increasing physical activity or changing eating patterns which make it difficult to attribute the cause of health improvements. Is the improvement in health due to the reduction in weight or to the increase in physical activity?
Also, while some people on weight loss diets lose weight in the first year, if followed for more than one year, people in peer-reviewed studies typically regain most of the weight back within the following five years. Repeatedly losing and regaining weight, or weight-cycling, increases the risk of heart disease and high blood pressure and is an independent risk factor for poor health outcomes, even in normal-weight individuals. Studies reveal that losing and regaining weight may be worse for a person's physical and psychological health than consistently staying at a higher weight.
Due to the issues with long-term ineffectiveness of weight-centric interventions, and increasing recognition of the relationship between racism and anti-fat bias, there is a need to shift focus to weight-inclusive or weight- neutral approaches. Weight-inclusive or weight-neutral approaches emphasize improving access to health promoting resources and reducing weight stigma. Studies have shown numerous health benefits, even in the absence of weight loss, are achievable and sustainable in the long-term using a weight-neutral approach.
One example of this approach includes Health at Every Size (HAES). HAES principles promote the acceptance of body diversity, intuitive eating not focused on weight control, support for policies that equalize access to resources, respectful care towards ending weight discrimination, and inclusive physical activity. Weight-inclusivity does not promote the message that everyone, in every body size, is healthy. What it does promote is that everyone, regardless of their body size, can be working on health-related goals without focusing on changing their body size.
Weight-inclusive approaches that are rooted in a social justice and systems-oriented framework can powerfully acknowledge the social and political roots of health inequities. To be most effective, and to avoid other forms of stigma or shame, these approaches should consider the influence of life factors such as poverty, discrimination, stigma, and job insecurity and how these factors constrain or support health behaviors and personal choice.
Research spanning the last decade has been showing that the HAES approach is associated with improvements in blood pressure, health behaviors, self-esteem, and body image and has done so more successfully than weight loss treatment. Further, studies show that interventions that encourage individuals to eat intuitively help participants abandon unhealthy weight control behaviors, improve metabolic fitness, increase body satisfaction, and improve psychological distress. Results from literature reviews favor the promotion of programs that emphasize a non-restrictive pattern of eating, body acceptance, and access to health promoting resources rather than weight loss.
There is a growing body of research showing that HAES and weight-inclusive approaches are better able to address overall health and wellness than focusing on BMI or weight reduction. Shifting focus away from weight loss, thinness, obesity prevention, and looking a certain way to achieve better health could potentially make us a healthier and more equitable society. Despite these movements being met with hesitation, weight-inclusive approaches have been demonstrated to be effective health promoting strategies.
Shifting the focus of health interventions away from losing weight as an end goal is not new and it doesn't even have to be that revolutionary. Many of the governmental recommendations to be physically active and follow a balanced diet following the Dietary Guidelines for Americans that UC ANR nutrition programs and CalFresh Healthy Living, UCCE programs teach in communities across California could be used in either a weight-centric or weight-inclusive approach. In our San Luis Obispo & Santa Barbara county nutrition programs we have advocated for books to be removed from curricula if they promote anti-fat bias and have started making changes in how we talk about our work to prevent chronic disease and promote health instead of preventing obesity. Still, the idea of obesity and overweight as the central concern for public health and popular media has stayed with us longer than has proven necessary or effective for actually improving the health of individuals and society.
Do you have unconscious bias toward overweight or obese people? Consider taking the Harvard Implicit Association Test for Weight.