I’ve been humming and ha’ing over writing this post for a while. I wanted it to be ‘perfect’ (no surprise). But chances are, I won’t nail everything down and it will continue to be modified and grow over the years. This was inspired by Cheryl Strachan’s post ‘why I can’t help you lose weight’. I realized, this is EXACTLY the kind of post we needed – because, the reality is, our team can’t either. This is Andrea here, writing it from my perspective. But all our staff at Ignite have read this over and agree whole heartedly on this philosophy. So let’s get into it.
I always tell people, the truth will set you free, but it will piss you off first.
It’s no surprise that, if you’ve been trying to diet and lose weight your whole life, and I step in and say that as a dietitian, I can’t actually help you with that, that it would piss you off.
And. That’s OK. And it’s also ok that you continue to hold the desire to lose weight. In a culture that stigmatizes people in larger bodies – it complicates and makes it hard to let go of this desire. The difference comes in acting on it as a moral obligation, versus observing and questioning it – and working towards things we CAN change instead. But before we get into weight loss desires – I should probably explain WHY we as dietitians, can’t help you ‘lose weight’.
Why not weight?
Weight loss, especially when a goal is set around a BMI, is not often achievable or maintainable.
We just don’t have data to support that long lasting, permanent weight loss is possible. Not only in research, but I’ll bet you can think of some real-life examples too.
Think of everyone you’ve ever known to be on a diet.
- Did they lose weight?
- Did they keep it off longer than 1 year? 2 years? 5?
- Have they ‘yo-yo’ed’ – meaning chronic dieting followed by subsequent weight regain?
- Did they end up at a higher weight than they started off with?
Hello?! The diet did NOT work if the weight came back.
We need to stop defining diets ‘working’ by their short-term success.
The reality is – the majority of diets fail. While some studies show participants can lose weight in the short term – most individuals regain that weight (80% – 95%). In fact, up to 2/3’s regain more.
So what IS the likelihood of losing weight?
- 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%
What about modest weight loss?
The yearly probability of achieving a 5% weight reduction is between 1 in 5 and 1 in 12. Depending on your gender and current BMI. In NAFLD (non alcoholic fatty liver disease) this number is often set at the target to prevent progression of NAFLD. And, the odds aren’t spectacular. So – how do we manage disease, when the evidence suggests that the treatment – weight loss – is often unsuccessful? Well – good news is – health behaviour change is ALSO helpful with this. Regardless of weight loss – and THAT is often missing from the conversation.
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 year.
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). 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.
So let me ask you – if you had a cold, and the doctor said ‘I have a medicine that 80% of the time doesn’t work for very long, and 50-80% of the time, will make you sicker’ – would it be ethical to prescribe? Would you WANT to take that medicine?
Then why is it ethical to prescribe diets? It’s not – but the actual issues behind this are quite complex. Starting with the desire to ‘do something’ and ‘help’ – to assuming that large bodies are an issue to be fixed with hard work, and ‘if they just worked harder’ they’d lose weight and be healthier. Weight is complex. It’s not ‘calories in calories out’. It’s social, psychological, biological, medical, and while influenced by nutrition, it’s also influenced by sleep, stress, environment, the gut microbiota, and SO MUCH MORE. See the influence diagram here.
Other issues with intentional weight loss:
- Yo-yo dieting (weight cycling) is HARD on your body. It has been identified as the cause of many negative health outcomes on blood pressure, metabolic rate, hormonal changes, blood sugars, cardiovascular markers
- Research assumes that weight loss reduces health risks. It assumes that the way to fix the risk associated with larger bodies is to get that individual into a smaller body. However, being in a smaller body to begin with – NOT the weight loss may actually account for the lower risk. More studies are needed to assess this. But, of course with weight regain being almost inevitable, this is very difficult to study. While being in a smaller body dispose you to better physiological markers, and short term weight loss may improve those, permanent weight loss is very unlikely. The long-term risks of intentional weight loss outweigh the benefits. (and – is there other ways, like health behaviour, to change those physiological markers rather than focusing on the weight? Spoiler alert- YES. So keep reading).
- MAJOR psychological impacts: It puts you at risk of poor self-esteem/self-worth issues & eating disorders and increases preoccupation on body and food. Talk about sucking the joy out of ACTUALLY living when all we do is think about our food and bodies!
- If you HATE your body and believe your self worth hinges on your weight – how good is your mental health? Probably not so great. (I’d argue the most important aspect of health)
- Weight loss is an OUTCOME of behaviour. Not a goal. (And, it may not be the same for everyone). When you perform a positive health behaviour with intentions to lose weight, but don’t hit the weight loss goal – what’s motivating you to continue a positive behaviour? With intentional dieting, the majority of the behaviours are not sustainable. They are not always positive either. (Annnnddd there is tons of complicated baggage that comes with subsequent weight regain and its impact on self-worth and self-efficacy).
So, are you ‘against’ weight loss?
If you lose weight, that’s fine. On the other hand, if you gain weight, that is ALSO fine. If your weight stays the same, guess what? Also, fine!
I am ‘weight neutral’ – meaning – that – I trust that your body will end up exactly where it’s meant to be when we fulfil your health related values – while making space for the fact that bodies are meant to fluctuate, and it may vary week to week, year to year. I’m not interested in manipulating your body – because I know it’s harmful to intentionally prescribe weight loss. Instead, I’m interested in improving your HEALTH. Because at the end of the day – that’s where we can make an impact.
What I AM against is diet culture, weight stigma and the oppression of people in larger bodies. When I say ‘all bodies are good bodies’ – everyone’s like – yes duh, (or even yes, but). But that statement does NOT come with qualifications. All bodies are good bodies PERIOD. If you’ve grown up on planet earth, you absolutely come along with health and weight biases. We have our 7 day health and weight bias course here. This course assesses your personal health and weight biases – and is something a dietitian and psychologist will help you unpack. They’re the ‘big assumptions’ we make that those in larger bodies must (blank) and those in smaller bodies must (blank).
But my doctor told me to lose X pounds ‘for my health’
While temporary weight loss may result in changes to blood sugar control, cardiovascular markers, etc. very few studies have looked at how this impacts risk. Was it the behaviour of eating more vegetables, or moving more that precipitated lower risk? Or was it the weight loss? A little tough to tell when studies don’t look at long term outcomes AND that diets fail. Meaning that the 5% of people that maintain the weight loss aren’t often enough of a sample size to really understand the results.
The fact is: we have NO good way to ensure long term weight loss in the majority of the population. BUT – what if we were to shape positive health behaviours that are ALSO associated with those changes to blood sugar control, cardiovascular markers, etc.? Would we have health benefits? And COULD they be long lasting? Yes – absolutely. Could weight change? There’s a possibility – but hey – if it doesn’t – look at all the other AMAZING benefits of positive health behaviour change. In fact, in a recent meta-analysis and systematic review (looking at multiple studies), they compared weight neutral health interventions to weight loss interventions. And guess what. They performed EQUALLY as well – WITHOUT THE RISKS dieting has. (see below).
“But there’s no harm in trying”
Yes – there is harm in trying. Dieting is NOT benign.
Weight cycling is hard on your body – especially in my patients with fatty liver disease, as just one example. Not to mention, dieting pre-disposes you to developing disordered eating behaviours or an eating disorder. It also pre-disposes you to having poorer self-esteem and one I think all dieters can relate to – being pre-occupied with food and your body.
The psychological impact of dieting has a small body of research that shows these impacts, but where I see it most is as a clinician. I’ve seen how traumatic food restriction has been for my patients. It impacts their relationship with others and themselves, their self-worth, and their ability to relate to food and their bodies in a positive way.
If weight neutral approaches have AS GOOD of positive outcomes as dieting, WITHOUT the risks – don’t you think we should do that instead?
So, you’re telling me I shouldn’t care about my weight?
I think there’s a lot to unpack with that statement. Our society puts VALUE on thin bodies. It marginalizes larger bodies. It treats them differently. These biases have a HUGE impact on how we view our own bodies – no matter what the size.
It’s not about NOT caring about your weight.
It’s making space for all the complex emotions that come up when we realize that maintainable weight loss is unlikely for 95% of the population. BUT – health, should you choose to pursue it, isn’t!
The broad assumption I often see is ‘if I’m thin, then I will be healthier’. The reality is – if you have positive health behaviours, you will be healthier. And while dieting MAY incorporate some positive health behaviours, it’s also wrought with physical and psychological complications associated with restriction. So – what’s a person to do?
Fix the Food Relationship and Shift Focus to Health and/or Wellness
At Ignite – we take a health at every size, weight neutral approach. Weight change is an outcome – not something we ‘strive for’ or look to modify. Instead, we look to improve health through behaviour change. Most importantly, we look at your health values. We want to help you to shape nutrition and lifestyle behaviour in a way that actually sticks.
So how do you work with patients?
We work with patients in a highly individualized way. But, I’m going to generalize some of the more common approaches we use:
- Assessing YOUR food relationship & diet history – what is your relationship like with food? Where did that all start for you? How does it shape your food behaviours and body image?
- What is your current ‘food reality’? – what ‘rules’ shape your food behaviours? What happens if we break them? Are they true?
- Understanding why diets don’t work – getting into the nitty gritty about the lies diet culture has sold you. It’s a 66-BILLION-dollar industry that thrives on repeat customers. Telling you that if you just lost weight you would be happier, have more friends, be richer, and SO MUCH MORE.
- Understanding how to get back to intuitive and normal eating. This looks different for everyone, but often starts with completely letting go of any food rules. Terrifying, I know, but we will help you through that.
- Depending on where you’re at with your nutrition and lifestyle, we may ADD something in from a nutrition behaviour piece. This often comes down to habit formation. This includes proper care for yourself, listening to your body and hunger cues, and ensuring that food is always available. Focusing on nourishing your body and ‘gentle’ nutrition will come as we more deeply understand how you relate to food and what nourishing your body will look like.
After the first appointment I always joke my patients end up in 2 categories:
1) over the moon – intuitive eating can be so freeing!
2) really frickin’ pissed at me – what the actual heck am I doing? I feel so lost! This is SO different than my comfort zone!
And – I’m here to hold space for both responses and neither is wrong. Undoing a LIFETIME of dieting, food restriction and rules, and assuming your body is wrong is hard. There’s going to be barriers, AND we’re going to talk through them.
Typically, from there, we continue to build on the principles of intuitive eating. Like honouring hunger and fullness, letting go of the desire to control intake and getting curious on what we eat and why, learning to trust our bodies, and when we’re ready, making space for gentle nutrition.
In terms of shaping that gentle nutrition & positive health behaviours we focus on:
- 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. As well as 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. Also, 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. As well as 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
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. Know that, if you’re looking to improve your health, health behaviours are 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 it is SO SO 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.