Why We Practice Weight Inclusivity

December 20, 2021

     Weight inclusivity and body acceptance are really important topics for me to cover, and hard ones for a lot of people to hear. I wanted to write this post to help clients, potential future clients, and my followers on the sidelines understand why I can’t promise them weight loss in my practice – and any practitioner (or diet product schemer) who DOES promise you weight loss is in the “wellness” business for all the wrong reasons. On the topic of diets, they DON’T work. If they did, we’d all be thin, happy, rich, successful – right? Aren’t these ideals what we are being fed by diet culture? (Diet culture, as Christy Harrison beautifully defines it, is “a system of beliefs that worships thinness and equates it to health and moral virtue, promotes weight loss as a means of attaining higher status, demonizes certain ways of eating while elevating others, and oppresses people who don’t match up with its supposed picture of “health”). So many people have the attitude of “I’ll be happy when I lose weight.” “I’ll start my side hustle and make more money when I lose weight.” Guess what? Your life doesn’t start when the scale tells you it does. It starts NOW- heck it started a long time ago! Please understand that there’s nothing wrong with your body. There ARE a lot of things wrong with society and the ideals we are fed about what our bodies should look like from the media.

     While it can be uncomfortable, I’m not afraid to have these really difficult conversations with clients. They come to me wanting to lose weight, they’re doing everything “right,” but somehow they just can’t get the weight off. What am I, as their trusted dietitian, to do? Do I put them on a severely calorie restricted diet, which WILL result in weight loss, but isn’t sustainable? Or do I ask the tough question, "why do you want to lose weight?" One of my clients recently told me that her doctor, who specializes in weight loss, told her “the quicker you lose the weight, the quicker you’ll gain it back.” This was her DOCTOR, who SPECIALIZES in weight loss! Admitting that she will probably [definitely] gain the weight back! I just can’t bring myself to tell people how to lose weight short term, when I know that 1, 3, 5, 10 years from now, the weight is going to come back. And this is why I identify my practice as weight inclusive, and aligned with Health At Every Size (HAES) principles. Maybe you’ve heard of HAES. Unfortunately, this isn’t a concept that student dietitians are taught in their schooling from their accredited universities, which is a total shame. Traditional dietetics programs put the health halo around weight loss and thinness, and the glorified BMI of 18.9-24.9 (I’ll save all the issues around use of BMI for another post). The following description of HAES is me MEGA-paraphrasing, but it gets some of the major concepts across. HAES “celebrates body diversity, challenges scientific and cultural assumptions, values body knowledge and lived experiences” and “values pleasure and honors internal cues of hunger, satiety, and appetite.” (You can read much more at haescommunity.com). HAES gets backlash when people take it to mean that all people in their current state are healthy. HAES does NOT automatically mean that you are “healthy” wherever you are currently. There’s a lot of other aspects of health to consider besides weight – metabolic biomarkers, mental health, social connections, and having joy and purpose in life, to name a few. What HAES wants us to know is that we can achieve these other aspects of good health without changing the shape of our bodies.

     So, how did I get to this place where I DON’T want to just be a “weight loss” dietitian? Well, I work a lot with teenagers (and adults) with disordered eating – many types- but most commonly anorexia nervosa (AN). AN is characterized by restriction, or eating significantly less food than the body needs. Calorie counting, macronutrient [macro] counting, and obsessively planning meals and snacks is common. Eating disorders put tons of strain on families. My experience in this area of nutrition has made me look at most eating behaviors through an eating disorder lens. When society sees these restrictive behaviors in a thin person, it’s “disordered” and “unhealthy.” But what happens when a person in a larger body exhibits these same behaviors? They are congratulated, and told “good for you!” Why are these behaviors not considered disordered in larger bodied people? Well, because society tells us that we need to be thin, so when a larger bodied person works to be thin, we see it as admirable. This is so backwards. When you work with me, I’ll be assessing for disordered eating behaviors even if you are in a “normal” or larger sized body. NO ONE should have to go through their life with an unhealthy relationship to food. It’s all-consuming, and there are so many other important things to worry about in this life.

     I understand that even after reading this post, there are still going to be tons of you who want to lose weight. And, for those who have lost a significant amount of weight and reversed conditions like high cholesterol or high blood sugar, I won't argue that sometimes, weight loss actually DOES contribute to improved health outcomes. The big picture here, though, is that we shouldn't put all our eggs in the "weight loss basket." So what will I help you do in a session with me? Well, we’ll look at all those things above that contribute to health. We’ll look at your health goals, besides weight loss. Odds are, and more often than not, when you start making changes that will positively influence your nutritional biomarkers (blood sugar, cholesterol levels) and mental health, you will lose weight. And if that is what you want, then great! But, weight loss shouldn’t be the primary goal.

     This post merely skims the surface of a topic that is way bigger than I can write about. We didn’t even touch on genetics, social justice issues, and the harms around weight stigma. But, if anything, I hope you can look at your own body, and others’ bodies, in a different way, and you have a sense of my general philosophy as a registered dietitian on the issue of weight loss.

     If you’d like to learn more about the issues above, I highly recommend the following podcasts:

     “Food Psych” with Christy Harrison

     “Nutrition Matters” with Paige Smathers