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The non-dieting approach

Dieting may cause more harm than good.

There is increasing acceptance that despite being in a country where having a high BMI is becoming the norm, dieting may not be the best way to pursue wellbeing.

We asked Dr Fiona Willer APD, practitioner and researcher from healthnotdiets.com for her perspective on the non-dieting approach.

How woDr Fiona Willeruld you describe the non-dieting approach you promote?

A non-diet approach supports health and wellbeing in the body you have, without aiming for weight change. For example, a dietitian using the non-diet approach counsels their clients with high cholesterol levels about dietary changes shown to sustainably optimise the blood lipid profile without relying on the temporary effect of an energy debt created by weight loss. A common framework used by professionals that endorse a non-diet approach are the Health at Every Size (HAES) Principles. Saying 'no' to the pursuit of weight loss, especially for much larger-bodied people, can require a great deal of bravery, given our very weight centric world. HAES provides skills to navigate internalised and societal weight stigma and empowers larger-bodied people to become confident self-advocates. 

 What brought you to focus your professional life on the non-dieting approach?

As a young person, I was told by my GP that I needed to lose weight. The 'sensible' weight loss diet that was endorsed by my parents was initially successful but ultimately led me down the path to significant weight fluctuations, body distress, an obsession with calories and nutrition, and eventually, a decade later, an eating disorder diagnosis. And, as is not uncommon for women with food and weight issues, a dietetics degree. My eating disorder treatment took an approach of unconditional body acceptance and coincided with my first year as a dietitian. This process of doing psychological work on myself, undergoing therapy and observing my clients in private practice with all-too-familiar stories, hammered home the unintentional harms that a weight centric approach can have. I could see that our dietetics profession, although well intentioned, had an incomplete understanding of the impact of weight loss dieting, negative body image and weight stigma, and many of our practices reinforced the development of disordered eating behaviours. I've been on a mission to change the profession ever since, including completing my PhD research in this field. 

There has been some push-back from more traditional weight loss focussed health professionals to this approach. Why do you think this is, and how do you respond?

I understand their position. Many health professional careers have been made from offering weight loss services, and it feels uncomfortable when someone suggests that your approach may be ineffective and/or confer harm to people despite your best intentions. Also, clients don’t expect a non-dieting approach, particularly from a dietitian. However, we now know that there are many people who are keen to pursue improved health, fitness and quality of life without being judged or monitored on the basis of their body weight. The RACP (Royal Australasian College of Physicians) and RACGP (Royal Australian College of General Practitioners) have both endorsed these ‘Health gain not weight loss' approaches in their most recent position papers. It will take some time for clinicians to upskill and change their practices accordingly. For larger-bodied people crying out for non-discriminatory healthcare, that time cannot come soon enough. 

Do you think there is a still a place for traditional weight loss approaches? In what circumstances?

My position is that the autonomy of the individual must be universally upheld. They should get to choose whether to pursue weight loss as a goal or whether to focus on other factors instead. However, this choice is not made in a vacuum. When there is widespread knowledge of effective alternatives and when societal prejudices about larger-bodied people become viewed as unacceptable, there will be a much-reduced place for traditional weight loss approaches. Pursuing weight loss would have to be established as scientifically valid in the long term for their specific circumstances and not used as a 'coverall' or 'add on' as it currently tends to be. 

What is it about our food environment and culture that has left so many people vulnerable to dieting harm and what can we do about it?

There are many aspects of Australian society that reinforce the idea that people with a certain body shape have more social currency and credibility than those with other body shapes.  We see this in public health messaging, medical advice, moral narratives, depictions of romance and love, the way beauty is discussed, and beauty products are advertised, even the way our newscasters look. Food itself is highly moralised, evident in the way foods are marketed as 'sinful' or 'guilt-free'. Companies that sell weight loss advice and products use these factors in their advertising campaigns, leaving out the poor long-term efficacy or potential risks of their products. The reality of long-term biological weight regulation means that achieving a smaller body size is usually a temporary state, sometimes leaving permanent damage (like decreased bone density) as a result. Distress, shame and disconnected eating habits from repeatedly pursuing unattainable weight goals are predictable results. For some these factors will prompt a spiral into an eating disorder. 

Increasing the visibility of larger-bodied people in society and professional life, neutralising our language about food, protecting people from discrimination on the basis of body size in our human rights laws and ensuring that weight-neutral health-supporting care is widely available will go a long way to addressing this important issue.

What tips can you offer to health professionals about how to navigate the path toward a more weight-neutral approach?

It's important to recognise that being competent in using a weight-neutral approach goes beyond simply having adequate approach application skills, such as being skilled in Motivational Interviewing and understanding the science and application of weight-neutral approaches. Health professionals wanting to use this approach safely must also undergo considerable introspective work, understanding their own biases and interrogating their weight-related beliefs, and recognise the societal advantages that their own body shape may confer and how these impact upon their therapeutic relationships with their clients. Because of this complexity, every path to this practice is unique. An important first step is to connect with non-diet approach health professionals, and an organisation that does this well is HAES Australia.

Glossary

Weight stigma: Weight-based discrimination arising from cultural attitudes and beliefs held about people based on their weight, shape or size.

Intuitive eating: Trusting inner body wisdom to choose foods that honour real hunger and feel good to eat without any influence of food rules and dieting culture. Making peace with food, respecting and dignifying your body and being kind to yourself.

HAES: The Health At Every Size® Principles are:

Weight Inclusivity: Accept and respect the inherent diversity of body shapes and sizes and reject the idealizing or pathologizing of specific weights. 

Health Enhancement: Support health policies that improve and equalize access to information and services, and personal practices that improve human well-being, including attention to individual physical, economic, social, spiritual, emotional, and other needs. 

Respectful Care: Acknowledge our biases, and work to end weight discrimination, weight stigma, and weight bias. Provide information and services from an understanding that socio-economic status, race, gender, sexual orientation, age, and other identities impact weight stigma, and support environments that address these inequities.

Eating for Well-being: Promote flexible, individualized eating based on hunger, satiety, nutritional needs, and pleasure, rather than any externally regulated eating plan focused on weight control.

Life-Enhancing Movement: Support physical activities that allow people of all sizes, abilities, and interests to engage in enjoyable movement, to the degree that they choose.

 

Learn more

Learn more about Health at Every Size (HAES) or the non-diet approach from healthnotdiets.com and connect with the relevant health professionals at www.haesaustralia.org.au.

 

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