What is weight inclusive care?
We live in a society with complicated and often intense feelings about body size. Truth be told, I originally chose to become a personal trainer and dietitian because I firmly believed if I could change or control someone’s size, it would “guarantee” good health. My early years were fixated on helping people “eat less and move more.”
But as I worked with more patients and clients, I realized my efforts to “help” were actually hurting their physical and mental health. It took a lot of learning and re-learning to challenge old assumptions and find a path that actually helped people in a sustainable way. It was an uncomfortable journey (to put it lightly).
As you read this post, you may experience some of those same feelings. The constructs we hold around weight, health, and virtue go deep. And for those of us who want to help people, will feel defensive to have beliefs and practices challenged. But if we are committed to helping, we also have to be open to learning as we gather evidence.
What is weight centric care and diet culture?
To understand weight inclusive care, you first have to understand key terms such as “diet culture” and “weight centric” / “weight normative” care.
First, “culture” is defined as a shared set of beliefs and social norms. Cultural practices are not necessarily “truths,” but rather narratives and social constructs that groups create to orient to and make sense of the world.
“Diet culture” centers around the idea and cultural norm that losing weight, being thin, and/or controlling size is a primary driver behind health. It puts being thin and the pursuit of thinness on a moral pedestal, thereby inversely perpetuating the idea that those not actively pursuing this are less moral or less “good.”
It positions decisions around food and/or movement as “healthy” only if they result in maintaining and/or controlling body size.
It attempts to neatly categorize food and movement decisions as “good” or “bad” and “right” or “wrong.”
“Weight normative” or “weight centric” healthcare follows similar practices and beliefs as diet culture. It positions weight management as the main determinant around health and health outcomes.
So what's the Problem?
You might be reading and think….so what’s the problem? I get it. I had similar feelings originally. But here are some ways in which that belief system is actually inconsistent with health and well being.
Defining Health
A key part of understanding the conflict is operationalizing “health.” Diet culture often presumes that what you see in a person’s appearance is indicative of their health. But this fails to account for the reality that “health” is about how well the various systems of the body are operating. It doesn’t explain how health conditions affect folks across the size spectrum. Because of this bias and misconception, it often leads to intensive screening for some bodies and reduced screening for others.
When I am talking about “health” with folks, I am reflecting on how well the systems of the body are operating, and whether their rest, nutrition, and/or movement are enhancing or hindering those systems. A consideration is whether or not the body is getting the amount and types of nutrients it needs to function properly.
Diet culture will often assume that “less food is better.” But this is in contrast to the research regarding how chronic “low energy availability” (LEA) can lead to down regulation of the various systems of the body, in a state called Relative Energy Deficiency in Sport (REDs). While this data is presented in the context of sport, the negative impacts of inadequate intake are also well documented in the eating disorder research. If a body is not able to operate in the way it’s designed, is that really health, even if a person is an “approved” size?
Exercise and Weight Loss
When folks use weight loss as a measure of whether or not their exercise is “working”, they often lose sight of the ways in which movement is helpful for the mind and body.
The value of exercise is not in weight control. It is in the adaptation(s) that come from challenging our heart, lungs, and muscles adapt and get stronger. Beyond biological benefit, movement also supports mobility, quality of life, emotion regulation, and mental health.
Trying to exercise to lose weight often leads folks to lose sight of those benefits. They may not give the body the time or the tools it needs to recover (aka, food) leading to declines in adaptation.
Folks may choose the duration and intensity of movement based on energy expenditure, not based on skill or available energy. It ultimately leads people to hurt too much, hate the process, and feel exhausted.
I often see folks start a workout routine they think they “should” do, and then quit because they didn’t lose weight. They weren’t willing to consider that movement could be valuable if it didn’t lead to weight loss. This focus leads folks to see movement as “punitive” instead of empowering and reduces consistency and efficacy in the experience.
Prioritizing Numbers Over Experience
Diet culture leads folks to get caught up in trying to eat based on numbers (or virtue). This can create problematic experiences that erode trust in the body.
For example, when folks set a calorie “budget” that is too low for their actual life, folks become reluctant to eat during the day and “save” their calories for the evening hours. Then they may find themselves “out of control” due to the combination of excessive hunger and emotional volatility.
Still others experience significant distress and confusion when their body is asking for food inconsistent with the formula, and feel torn about how to respond, even if it was what the body needed.
Eating to create an energy deficit often leads to “dysregulation” within the body. The body notices it doesn’t have the nutrients it needs, and in turn increases thoughts, appetite, and desires for food to come back to balance. The body’s job is to maintain homeostasis (that includes nutrient status) – it is not try to “trick” us into doing something problematic. It’s our belief that the mind (and a formula) is more intelligent then our body that leads us to feel in opposition to one another.
What is weight inclusive care?
As so wonderfully said by Dr Tracy Tylka,
The weight-inclusive approach rests on the assumption that everybody is capable of achieving health and well-being independent of weight, given access to nonstigmatizing health care.
This approach challenges the belief that a particular BMI reflects a particular set of health practices, health status, or moral character.
Under this paradigm, weight is not a focal point for medical treatment or intervention. Weight is not viewed as a behavior, but eating nutritious food when hungry, ceasing to eat when full, and engaging in pleasurable (and thus more sustainable) exercise are self-care behaviors that can be made more accessible for people.
In practice, I see weight inclusive care as –
- Treating every body with dignity and respect – honoring lived experience and orienting care in a way that supports overall well being
- Making sure the mind and body have the amount and types of nutrients it needs to grow, develop, function, adapt, and thrive
- Ensuring that our approach to eating and movement isn’t costing us our mental, social, or financial health
- Learning how to listen to and honor the language and wisdom that comes from the body, while using our knowledge of science to support our well being.
- That does NOT mean eating whatever we want, whenever we want. But rather learning how to interpret signals from the body before, during, and after in a curious, compassionate way
- Increasing neutrality around eating and movement experiences – to help folks separate past pressure / emotional experiences from their deeper desires / values
- Exploring movement that feels reasonable for our well-being – that enhances our quality of life and function
Since weight inclusive care is not based in fear and vigilance, folks often mistakenly belief the goal is to be “apathetic” about their food / movement. But that couldn’t be farther from the truth.
The goal is NOT to ignore our needs or follow every desire we have. But rather to learn how to approach food / movement with respect – understanding how we can use these variables to support the function of our body, without getting distracted by our beliefs / misconceptions about size.
A large part of the care model holds space for the reality that “health” is not accessible for all bodies. Moreover, the achievement and/or pursuit of health is not a moral imperative that makes a person more or less worthy of care, dignity, and respect.
Does that mean I can't / won't lose weight?
There are folks whose weight changes as part of the process, but the more weight change / control is the “goal”, the harder it can be for folks to truly trust the cues from the body.
A big part of the weight inclusive care is encouraging folks to focus on exploring and developing an eating and movement plan that aligns with their skills, values, and desired quality of life, and giving permission for the body to do as it’s designed.
That doesn’t mean we can’t challenge the body to see what it can do in terms of performance! But making sure that the pursuit isn’t coming at the long term health of our mind or body.
How do we know if it's "working?"
There are so many ways to understand whether or not a given behavior is supporting a person’s health or well being. Here are a few examples I often monitor with clients:
I am not “anti weight loss” by any means. I strongly believe in body autonomy – it is your body and it is completely your choice how and what you do. But if your primary goal is weight change and you’re less interested in expanding on that definition of health, I may not be the provider for you (and that is ok). The care philosophy you choose is completely up to you!
What I do hope, is that folks consider to what degree their weight loss pursuits are consistent with the pursuit of physical and mental health. It’s not as simple as you’d think.