Wellness Wednesday: What is Health at Every Size?

You know diets don't work, but what if you still want to get healthy? Get the answer to what is health at every size and how it can help you achieve health without dieting. 

What is Health at Every Size? Learn how to get healthy without dieting.
What is Health at Every Size? Learn how to get healthy without dieting.

I've had this post in mind to write for quite some time, but I kept putting it off because it seemed like such a daunting task to put it all on paper, err, the internet. But a few things happened in the past few weeks that served as a reminder how important it is to get this information out there.

Being a dietitian, I'm regularly approached by potential clients, friends, family and sometimes strangers, looking for advice on how to lose weight. Motivations vary, but more often than not, it's about getting healthy. Sure, they'd love to fit in smaller clothes and "improve" their appearance, but generally, it's health that's the main driver.

It always comes as a surprise when I tell them, "I don't do weight loss." Eyes squint. Heads tilt. Jaws drop a bit. They don't say it, but I can basically see them thinking, "Ummmm, aren't you a dietitian? Isn't that, like, what you're supposed to do?"

Short answer: no. As a dietitian, my job is to empower people to reach and maintain their optimal state of wellness using food and eating as a tool. My goal is health, not thinness. Thinness does not equal health, nor is achieving thinness a guarantee of health.

That's because health is not a size. 

I'm not a weight loss dietitian because science doesn't support the idea that purposeful weight loss is sustainable for more than a small minority of people. I'm sure you saw last weeks article in the New York Times on the study done on participants of The Biggest Loser. The study showed their bodies burned about 500 calories less than expected for their size. That, along with the fact that their bodies were producing more of a hormone that promotes hunger and less of a hormone that blocks hunger, is the the likely reason why all except one had regained much of the weight they lost. Many read this as shocking new news, but really, this is something that has been well known in the field for years. While study after study fights over what type of eating pattern is most helpful for weight loss (almost always focusing on the first 2 years), study after study shows the vast majority of dieters regain weight (up to 95%) and 40% regain even more.

When I was at my parents home this last week, The Biggest Loser news came on Good Morning America. My dad said to me, "You know, I think that news is pretty discouraging. I can see a lot of people, myself included, who would hear that and want to give up."

I hate that it's being interpreted that way, but I understand why. In our society, weight is often equated to health. Hearing the news that weight loss might not be possible must feel on par with getting diagnosed with some horrible, incurable disease.

But I'm here to say there's no reason to feel hopeless because you can be healthy without dieting. In my practice, I embrace a movement called Health at Every Size (HAES). Simply put, HAES focuses on adopting healthy behaviors with a goal of health, not weight loss. With HAES, body size does not determine health, which is evaluated in a much more holistic way, looking at presence or absence of physical/mental illness, fitness, social connectivity, eating patterns and relationship to food, sleep, stress and so much more. Basically, with HAES, it's impossible to judge someone's health simply by looking at them.

This may be a scary thing to hear if you're unhappy at your current size. Besides the societal pressure to look a certain way, we've all heard so much information about the dangers of excess fat, making the idea of being overweight somewhat terrifying from a health perspective. But I think the information is, in a sense, misrepresented. It's not an obesity epidemic, it's a crappy lifestyle epidemic. Weight is simply one side effect you can see.

By focusing on a side effect (i.e. weight), not the cause of health problems (i.e. behaviors), it creates a huge distraction. Your actions will end up addressing the number on the scale, and usually in a way that's not sustainable. When you focus on weight, you eliminate sugar instead of looking at why stress is leading you to overeat candy and muffins from the snack room everyday at 3 pm. When you focus on weight, you go to the gym and pound away on the cycling machine for 45 minutes then don't move the rest of the day because you're exhausted, rather than finding exercise you enjoy and can sustain and working movement in throughout the day. When you focus on weight, you give up and resort back to unhealthy behaviors when the scale stops moving, because even if the behavior changes you made were healthful, "it's not working."

Focusing on weight loss as an outcome also marginalizes a large group of people (no pun intended) who simply have larger bodies. Size diversity is real. There has always been a wide range of bodies, even before the advent of modern processed food and agriculture. Who am I to say a 250 lb ultramarathon runner, a plus-sized yogi who can hold advanced poses that I can't get into even for a split second, or a zumba instructor with "200 pounds to lose" are unhealthy? These are all women who are eating normally and are very active. Sure, they could go on a diet, but science tells us there's a 95% chance it will do more harm than good. Would you take a pill or undergo surgery that had a 95% chance of making your condition worse?

Focusing on weight also ignores the fact that there are many difficult to treat medical conditions, like hypothyroidism and PCOS, that make it very hard to lose weight. Also, a history of dieting can raise one's "set point weight." It's a weight range that varies from person to person, based on genetics and life experience, where the brain will fight to stay. It also causes people to ignore health concerns of thin people, who are also suffering from the same crappy lifestyle epidemic in pretty equal numbers. Recently, I had a doctors checkup and when the nurse checked my blood pressure, it was WAY higher than what's normal for me. When my doctor was reviewing my chart, they told me, "Everything looks great! Your weight is great, your blood pressure is great..." I had to stop them and point out how high my blood pressure was in comparison to the last four years. Luckily, as it turns out I had taken Dayquil earlier that day which causes blood pressure to go up, but had I not, a pretty serious health issue could have been missed because I'm thin, so I must be healthy, right?

For those of you who know dieting doesn't work, but the idea of working with someone on a weight-neutral approach is somewhat terrifying, here's a look at how I implement HAES into my practice: 

  1. Size acceptance. No matter your size, I accept you as you are and I work to help you do the same. No one knows what you size will be when you're at you're healthiest, so let's work on appreciating your body as it is now. I've said it before and I'll say it again - you can't take good care of something you hate.
  2. Building trust in yourself. You have internal systems in place that are designed to keep you at a healthy weight, but years of dieting have suppressed those cues and signals. Using intuitive eating strategies, we'll tap back into those cues so you can eat when you're hungry, stop when you're full, and savor mindful indulgences without setting off a cascade of guilt, shame and binging.
  3. Adopt healthy lifestyle habits. Habits are things you do consistently without even thinking about it. Using a small step approach, we create healthy habits that make it easy for you to enjoy tasty, nutritious and balanced meals, move your body regularly and support your emotional needs.

And what about your weight? I somewhat hate to bring it up because the whole idea of HAES is to put weight loss on the backburner. But, it's a question and concern I hear frequently. If you're above your set point weight, which you likely are if you're overeating, binging, ignoring hunger/fullness cues, skipping meals, and emotionally eating, you'll likely lose weight. If you're under your set point weight from over-restricting calories to the point where you're always hungry and constantly preoccupied with food, you may gain weight.

If you're interested in working together on a weight-neutral approach to your wellness, please feel free to check out my coaching philosophy and coaching services and shoot me an email. Happy to set up a free 15 minute phone consult to discuss your needs and see if we'd be a good fit to work together!

Would love to hear your thoughts on this, including your questions and concerns. Happy to discuss in the comments, but please, keep it nice. It's always astounding to me how nasty people can be when it comes to embracing size diversity.