What does it mean to be weight-neutral?

Our healthcare system is structured around the idea that larger body size equals disease and morbidity. The emphasis that weight and body size are the only contributing factors to disease is not accurate and inappropriate. Unfortunately, many practitioners still rely on this aged medical advice to guide their care.  

Weight neutrality is an approach in healthcare that shifts the focus away from weight loss and towards non-weight, health-promoting behavior change. A weight-neutral practice emphasizes overall well-being from a holistic approach.  

What we know

We know that weight stigma dramatically influences a person's desire to engage in preventive care. Weight stigma and bias are defined as discrimination based on someone's weight and size. An individual may experience medical weight stigma if their body composition does not conform to society's body and shape norms while seeking medical care. Weight stigma has significant negative medical impacts that can perpetuate chronic disease. 

Consequences of weight stigma

Research shows that individuals who experience weight stigma have increased adverse medical exposures that result in:

• Higher rates of misdiagnosis 

• Decreased patient care time

• Care implementation based on outdated medical guidelines, such as BMI thresholds

Research also recognizes that individuals who experience weight stigma are at increased rates for:

• Disordered eating

• Binge eating

• Depression & Anxiety

• Decreased desire to engage in health-promoting behaviors

• Decreased engagement in preventative care

• Decreased quality of life 

Weight Neutral Approach

When a practitioner takes a weight-neutral approach, they will work with the individual to develop behavior changes that will positively impact their overall health that do not focus on intentional weight loss. When implementing health-promoting behaviors, an individual may experience weight change, both loss or gain, as the body finds homeostasis or its set point weight. When our body is engaged in appropriate physical activity, is adequately nourished, and is stabilized for chronic stress, it will find homeostasis. Adherence to health-promoting behaviors is critical. Through introspective awareness, individuals will discover that movement, nourishment, and stress management feel good, and these behaviors will be sought out. Therefore, the health-promoting behaviors should be individualized to the patient and tailored to what is manageable and feels good. 

Health-Promoting Behaviors 

Health-promoting behaviors are non-weight-centric behaviors that are linked to improved quality of health. Evidence supports that engagement in health-promoting behaviors shows an overall improved quality of life, regardless of BMI. 

Such behaviors include:

• Getting adequate sleep

• Regular, accessible physical activity 

• Eating a diverse diet

• Enagagment in stress managment techniques 

• Building social connections

• Staying hydrated

• Avoiding tobacco, alcohol, and drugs

Let's take a second to talk about BMI

BMI has been getting some attention recently since a growing body of evidence exposed the numerous flaws of BMI. BMI is a measured relationship of weight to height that determines a person's body size classification. It does not consider any other measurements. BMI is commonly used to qualify patients for certain levels of medical intervention. Individuals with higher BMI may experience weight stigma if appropriate medical care is unavailable solely based on their BMI. The use of BMI also disproportionately impacts individuals from different racial backgrounds who may naturally fall into a higher BMI category. The American Medical Association recently published new guidelines urging practitioners to avoid solely using BMI to diagnose obesity and look more holistically at a patient. The new guidelines encourage medical providers to gather other measurements of health, such as relative fat mass and underlying medical or genetic conditions, to name a few. Numerous factors can contribute to an individual's size beyond diet and exercise. These factors may include but are not limited to genetics, environment, medication, medical conditions, access to care and food, a stable environment, etc. Our bodies are not one size fits all, and our medical interventions should not follow rigid isolated measurements such as BMI. 

How do you express your desire for a weight-neutral approach in your care?

Being your advocate, particularly in a medical setting, can be challenging. However, you have a right to appropriate medical care, and your practitioner needs to know your concerns so that they can appropriately care for you. Here are some ways to advocate for weight neutrality:

• Express your desire for weight-neutral care. If they can not respect your wishes and you are medically stable, you may need to seek a new practitioner who is better aligned.

• Find a practioncer who is a certified intuitive eating counselor or identifies with the HAES principles. (Health at Every Size)

• Ask for recommendations that are not tied to weight loss. Can you do specific exercises to help with joint pain regardless of body size? What are the long-term results of weight loss for the condition they are recommending? Was weight cycling controlled for in studies they refer to?

• Ask for a blind weight (not identifying weight at a doctor's visit or standing backward on the scale). You may also ask if a weigh-in is necessary for that medical appointment and if it can be skipped if this is a triggering event for you. 

If you would like to explore your relationship with food with nutrition counseling from a weight-neutral place, please reach out today.