Why work with a weight-inclusive dietitian?
Perhaps you’ve seen the terms “weight-inclusive care” thrown around on social media, or you have a friend who’s mentioned they’re working with a weight-inclusive dietitian or other healthcare provider. If the idea intrigues you but you’re not quite sure what’s different about it, or if it’s a good fit for you, this post will hopefully shed some light. I’ll share my professional journey toward adopting a weight-inclusive approach as a foundational principle in my clinical practice, give you a little background on what the term means and evidence to support it as an ethical and patient-centered approach to healthcare, and then explore some specific ways we work within that framework to improve your health and relationship with food.
Although I began my career as a dietitian in a weight-centric role in a well-respected bariatric surgery and medical weight management clinic, I shifted away from that approach because my experience with patients suggested it was deeply flawed and missing the mark. Despite initial weight loss success after participating in a “gold standard” comprehensive weight management program supported by an incredible team of doctors, dietitians, and psychologists, as well as group support and lifestyle education, many patients were not losing weight or were returning to the clinic after having regained weight (sometimes the entire amount they’d lost), feeling a sense of deep shame and anger toward their bodies and chastising themselves for being “bad” at their diet or falling off their plan. They were counting every calorie, stuck in binge/restrict cycles with foods they considered off-limits, trying to implement exercise routines that were excessive and unsustainable, and obsessively checking their weight. Every bite of food stressed them out, they were avoiding being in photos, and they were putting off joyful experiences like vacations and weddings until they lost weight. This was simply not OK with me – I became a dietitian to help people feel more connected to their bodies and build confidence in their eating habits. The spiral into self-criticism and disordered eating behaviors was disturbing to me. I dove into self-study of the science around weight regulation, the harmful effects of weight stigma, and the psychology of disordered eating. My counseling with patients focused on building self-compassion and more connection to their hunger, fullness, and satisfaction cues, “legalizing” foods they’d been restricting (in order to curb binges and improve the quality of their diet), and practicing self-acceptance skills to improve body image. I found this approach much more values-aligned for me, but hard to practice when the primary goal was weight loss. This friction ultimately led to my professional embrace of weight-inclusive care and my shift into a focus on treating disordered eating and eating disorders.
What is weight-inclusive healthcare and how does it apply to nutrition counseling?
Weight-inclusive healthcare offers a respectful pathway toward improved health and well-being for all individuals regardless of size. Weight inclusive healthcare treats the whole person and addresses the myriad ways health can be enhanced outside of managing weight. In addition, it also seeks to counter the harm caused by weight stigma and diet culture. It’s an alternative to weight-centric care, which is the predominant lens through which the medical community views health and asserts that better health is attained through weight control within an “ideal” range.
A weight inclusive approach has these overarching tenets at its foundation:
There are better, more accurate ways to measure a person’s health than by using their weight or BMI. The relationship between weight and health is complicated and murky. The body of research that looks at this relationship is correlational (not causal), biased, and flawed. The majority of studies that try to track health risk along the BMI continuum fail to account for several confounding factors that may impact health outcomes, like social determinants of health, weight stigma, dieting history, and trauma history. In contrast, there are numerous studies that point to things like the nutrient-density of the diet, physical activity, meditation, and quality relationships (to name just a few) as indicators of and avenues toward good health.
Weight loss maintenance doesn’t seem feasible for most people. Despite decades of time and money devoted to “the obesity epidemic”, we still don’t have a low-risk, sustainable intervention that works for the majority of people. (And yes, I’m considering the GLP1s in this statement!). Regardless of how the weight was lost, most people will regain some, all, or above and beyond the amount of weight lost over a period of time (usually 6 months to 2 years in the research). This is a well-known and accepted phenomenon that the field has been trying to “figure out” for a long time. I’ve gone to many an academic talk where these data are presented as a big conundrum in the weight loss world. The reality is, these human bodies evolved to endure prolonged famine, preserving energy to maintain all the functions necessary for life. We’ve evolved to maintain or gain weight relatively easily because it protected us from starvation when running to the store for a snack wasn’t an option. Our bodies register weight loss and food restriction as a threat and they’re very good at protecting us against that threat.
Weight loss interventions and chronic dieting carry risks, including nutritional deficiencies, cardiac abnormalities, hormone imbalances, loss of lean body mass and bone density (increasing risk of fall and fracture as we age), depression, anxiety, and increased risk for eating disorders. In addition, there’s a body of evidence suggesting that weight cycling (repeated cycles of losing and gaining weight because of dieting) can increase cardiometabolic risks.
In weight-inclusive nutrition counseling, we shift our focus away from using food and exercise to control weight to supporting holistic health-promoting nourishment that improves overall well-being and quality of life for the body you’re living in right now. It’s not just for those struggling with disordered eating - weight-inclusive nutrition care is for everyone and is a framework that applies to any health concern traditionally linked to weight.
To get a sense of what this process would look like specifically for you, you might ask yourself this question: “What is it that I’m hoping weight loss will improve for me in my health and my life?” We take that question, and we start looking into other avenues to achieve those goals that we can work on right now. Here are some examples:
Meal planning that prioritizes foods that you enjoy and supports energy, focus, and mood
Trying new foods that will aid in managing a health condition like type 2 diabetes or high cholesterol
Building attunement to hunger, fullness, and satisfaction cues to feel more connected to your body
Exploring more enjoyable and realistic movement practices to increase strength, stamina, and flexibility
Making connections between food and mood to discover the role food plays in the way you navigate difficult emotions and attempt to regulate yourself
Increasing flexibility with food so you can enjoy more diversity and variety in food choices, as well as spontaneous food-related adventures with loved ones
Improving body image confidence through unpacking anti-fat bias so you can feel more confident wearing clothes you love, taking trips you’ve been putting off, or otherwise engaging in a full life
Advocating for more inclusive healthcare with other providers to reduce your chances of experiencing weight stigma as you care for your body’s needs
This is not an exhaustive list – there are so many meaningful and effective ways to address our needs outside of managing weight. My commitment to weight-inclusive care has only deepened over the years as I’ve seen my clients thrive in their physical and mental health after giving themselves permission to step off the weight loss roller coaster ride.
Understandably, this might sound like a pretty significant paradigm shift. Perhaps weight loss has been a primary goal in your life for a long time – one you have organized a lot of your decisions around. Many of us have internalized the idealization of thinness from a tender young age. It’s OK to not feel 100% ready to embrace the approach. But if you’re curious, I invite you to reflect on a question: if weight loss was no longer a goal, what would that free me up to focus on instead? Whether after answering that question you’re cautiously optimistic or fired up and ready to jump in, I’d love for you to reach out to see if we’re a good fit to work together!