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A Weight Neutral Approach to Nutrition Counselling

Feature, Food Relationship, Healthy Eating, Women's Health | December 13, 2020

Green vegetables, nuts and fruit smoothies spread across a kitchen table.
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Have you heard of a ‘weight neutral’ approach? At Ignite, we practice in a Health at Every Size® paradigm, with a weight neutral approach. In this post, we will explain what that means and how it applies to our practice, so you can find the right fit of dietitian.

What is Health at Every Size® (HAES)?

HAES® is an evidence-based approach that challenges assumptions about the relationship between weight and physical health and supports individuals of all sizes in addressing health directly by adopting health behaviours, rather than manipulating weight.

HAES® emphasizes inclusive respect for every body, challenges scientific & cultural assumptions, and focuses on compassionate self-care.

HAES has 5 key principles -this is how they are applied at Ignite Nutrition:

  1. Weight Neutral Approach: At Ignite Nutrition, we follow a weight-neutral approach, with a focus on health behaviour change rooted in your values. Our goal is to improve our client’s relationships with food, remove moral judgments around food, build awareness of hunger and fullness cues, and emphasize emotional and physical health over the desire for a thinner body.
  2. Health Enhancement: We promote positive health behaviours that are meaningful and sustainable and will go a long way in your overall health.
  3. Respectful Care: All of our staff follow the HAES principles and are aware of the risks of dieting and weight bias. The language used at Ignite Nutrition in counselling, online and in promotion materials uses body inclusive messaging, and promote health at every size. We continue to grow every day in our understanding of social justice, and understand that the best person to learn from is you.
  4. Eating for Well-Being: We promote a food-first approach to health. We like to remind patients that weight is an outcome of which we don’t have entire control, not a goal. We work to understand your relationship with food, and how we can positively shape it. From there we can focus on gentle nutrition. We encourage balanced meals and snacks for energy and enjoyment. We focus on flexibility, and positive habit formation, not food rules.  We do not promote dieting behaviors.
  5. Intuitive Movement: We provide clients with a holistic approach, looking at nutrition and lifestyle behaviours to help work towards their overall health goals. We encourage all clients to move their bodies within their abilities through means they enjoy – and will help to unpack beliefs around movement and find movement that works for you!

What to Expect with a Weight Neutral Approach

You may expect to attend a dietitian appointment being weighed, measured, and then goals set based on weight. In fact, many of our patients are surprised that we don’t set goals based on weight!

 

weight neutral approach to nutrition counselling at Ignite Nutrition - Canadian registered dietitians

So how do you work with patients?

We still focus on health – but define it based within your personal values.

What we do isn’t that different from a weight-centred paradigm many times – we just shift the focus off weight and focus on building sustainable health behaviour change, finding intrinsic and extrinsic motivators that build you up, rather than tear you down.

  • Value based goals: Identifying your health goals outside of weight (because when we pursue weight loss – what is it we’re really pursuing? Safety? Feeling accepted & loved? Being validated, liked, important? What is that desire to lose weight REALLY about?)
  • Adding nutrition in because it FEELS good. No strings, morality, or pass/fail attached. Simply, getting back to fuelling your body in a positive way and making space for the fact that our lives are constantly changing, and so too will your nutrition.
  • Taking note of foods you enjoy, and foods that make you feel good – and incorporating good nutrition in to support your overall health and wellness (this is especially important in our digestive health patients!)
  • Stress management – helping to improve how you respond to stress, especially if it’s associated with using food as a negative coping behaviour. We have an INCREDIBLE psychologist on our team that works with a lot of our food relationship patients.
  • Intuitive eating and body trust – knowing your body can regulate its nutrition intake – if we give it space to do so
  • Intuitive movement – finding movement that feels good for your body, that you enjoy
  • Skills & habit formation – building a positive environment to support making nutrition decisions aligned with your values, improving confidence and competence in the kitchen (if that’s your thing) and building on skills to fuel your body in a positive way
  • Being an ally in your health – knowing that relationships and social connection are arguably MORE important than food and exercise – being part of that positive support system on your health journey

Why we don’t set health goals based on weight

Setting goals based on weight alone doesn’t take into account that health can be achieved at any body size and often it implies that size is the only valuable indicator of health. This is often a focus in our health care system, setting ‘target BMIs’ for patients.

This happens frequently with our NAFLD (non-alcoholic fatty liver disease) patients. We understand the doctor may have prescribed a target BMI. What we want to shift the focus to is health behaviours and values. Weight is an outcome (one that isn’t totally in our control, as we’re led to believe!) not a goal. 

Why don’t we focus on weight as a goal? Because when we set goals solely based on weight, or body composition, we miss out on all the benefits moving, fuelling our bodies positively, and other lifestyle factors have on our health, regardless of weight.

What is also missed from conversation about weight loss and setting target BMI’s is the constant ‘not enoughness’ patients experience with that. The onus is often put on the individual – “if you just ate right, and moved more – you would be the ‘right’ body size”. If diets worked, we would all be within a prescribed body weight. Unfortunately it’s not that simple.

While you might be prescribed weight loss by a doctor, and have a weight loss goal in mind – we take a bit of a different approach to that – challenging some beliefs around health and bodies, while also recognizing its completely normal desire to have. Let’s talk about what’s missing when we prescribe weight loss as a goal.

What’s Missing From the ‘Prescribe a Weight Loss Amount’ Conversation?

Great question. What’s missed is the likelihood of losing and maintaining that weight loss1

  • If your starting BMI is 30-34.9, the yearly probability of achieving a BMI less than 24.9 is 0.5-0.8%
  • If your starting BMI is 40-44.9, the yearly probability of achieving a BMI less than 24.9 is 0.07-0.15%.
  • The yearly probability of achieving a 5% weight reduction is between 1 in 5 and 1 in 12, dependant on your gender and current BMI.

How likely is it to keep the weight off if I do lose it?

There is minimal evidence for successful long-term maintenance of weight loss. Many studies have looked at short-term weight loss and correlated these findings to improved health outcomes. However, a very small number of people actually maintain weight loss long term.

In the study cited above looking at health records of over 175,000 people over 10 years they found that 50% those that do achieve a 5% weight reduction regain that weight in 2 years. If they’ve achieved a 10% weight reduction, 80% of those regain the weight in 1 year1.

In a meta-analysis that combined the results of 29 different studies, it showed that 5 years after participating in structured weight loss programs, participants maintained a 3.2% reduction in weight (approximately), and the study did not consider how weight cycling and subsequent diet attempts influenced weight, nor did they consider diet quality or the psychological impact of very low calorie diets2.

We GET these numbers are discouraging when you’ve been told your whole life that thinner is better and that weight loss for health is a ‘must’. BUT. We bring them up because they’re missing from the conversation about weight and health and we feel they’re key to bring up.

So you’re saying I shouldn’t want to lose weight?

Nope – not at all! We live in a world that values thin bodies and stigmatizes those in larger bodies. We’re prescribed weight loss and assume that thinner people are healthier, or take better care of themselves. If we do live in a larger body, society reminds us time and time again that this is something to be ‘fixed’. This is called weight stigma.

Our job isn’t to change your mind – it’s to take a health journey alongside you and help you explore health and wellness, while gently challenging and expanding your lens of perspective.

By weight neutral, we mean that we find value in health behaviour outside of weight loss. Whether you lose, gain, or stay the same – we’re here to hold space for all of it, and it is not what we set the goal-posts by. 

So. This is why we don’t take weights. We don’t set weight loss as a goal. We make space for the whole spectrum of bodies and knowing that, if you’re looking to improve your health, health behaviours and a positive relationship with food and your body is what counts – and we’re here to support you in that. If you have a history of dieting, or assuming that the body you have isn’t good enough -the work is hard, but so worth it – and we’re here to support you on that journey.

To get started with something radically different today, book with one of our dietitians here.

weight neutral approach to nutrition counselling at Ignite Nutrition - Canadian registered dietitians

 

References

  1. Fildes, A., Charlton, J., Rudisill, C., Littlejohns, P., Prevost, A. T., & Gulliford, M. C. (2015). Probability of an obese person attaining normal body weight: cohort study using electronic health records. American journal of public health, 105(9), e54-e59.

  2. Anderson JW, Konz EC, Frederich RC, et al. Long-term weight-loss maintenance: a meta-analysis of US studies. Am J Clin Nutr. 2001;74:579–584