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Do No Harm: Embrace Health at Every Size
The frantic focus on weight in relation to health has been detrimental to our society and the individuals within it. The use of terms like “overweight” and “obese” are misleading and are used to designate an assessment of health, which is unfounded. The use of these terms in this article will be used in quotation and limited to referencing research. The quoted use of these terms is not intended to legitimize them and does not reflect on the accuracy of these labels.
In our society, we are constantly pummeled with headlines cautioning against weight gain or living at higher weights. The reality that newer research indicates those with BMIs in the “overweight” and “obese” categories actually experience a protective health benefit and increased longevity, even in cases of people living with actual diseases such as diabetes and hypertension (Bacon, L. & Aphramor, L. 2011).
There are many myths surrounding “obesity,” and one of those is that it indicates a state of being unhealthy. In fact, the “overweight” and “obese” categories have been correlated with a lowered risk of mortality (Campos, P. et at. 2005). When people in these ranges do have diagnoses such as type 2 diabetes, hypertension, and cardiovascular disease, research indicates prolonged longevity in comparison to their thinner counterparts with these illnesses. (Bacon, L. & Aphramor, L. 2011).
Health at Every Size – The Danger of Weight Loss
Clinicians will often cite the evidence which suggests a correlation between higher BMIs and diseases, and they do so without a full understanding of confounding factors. Many people at higher weights have experienced years of weight-cycling (weight loss and regain), often at the recommendation of well-meaning practitioners.
These fluctuations in weight have been associated with inflammation, poorer cardiovascular outcomes, and increased mortality (Bacon, L. & Aphramor, L. 2011). When studies do control for confounding factors, including weight-cycling, the risk for disease reduces dramatically or disappears altogether (Campos, P. et at. 2005). It appears the problem does not lie in being at a particular weight, but rather it is the weight-cycling that is the danger.
The proposed “solution” to the “obesity problem” has traditionally been weight loss. In order to achieve this, clinicians recommend some type of restriction (either macronutrient categories or calorie levels) and possibly increased activity. Extensive research has failed to indicate any means of an effective, long term method for sustained weight loss.
What has been discovered instead is that a large number of people will regain more weight than was lost, leaving them at above baseline (Mann, T. et al. 2007). The National Institutes of Health found that up to 67% of individuals will regain their weight within a year, and nearly all will regain by five years after the loss. In fact, dieting in any form is one of the strongest predictors of weight gain (Bacon, L. & Aphramor, L. 2011).
Weight loss has actually been associated with an increased risk of mortality (Ingram, D. & Mussolino, M. 2010). Even in studies indicating short term improvements in health measures, this benefit typically disappears over time, even in the rare cases where weight loss is maintained (Bacon, L. & Aphramor, L. 2011).
Insufficient information is available regarding the type and extent of strain placed on the body under restrictive dietary intake. Blind recommendations for weight loss are arguably causing more harm than benefit (Bacon, L. & Aphramor, L. 2011).
The Ethics of Recommending Weight Loss
Body dissatisfaction is associated with an increased incidence of binge eating and other eating disorders. It is also associated with increased weight gain over time (Puhl, R. & Heuer, C. 2010). Body image has been seen as more predictive of health outcomes than actual body size (Bacon, L. & Aphramor, L. 2011).
Weight stigmatization ultimately demotivates health-related behavior changes. Reactions to this stigma include increased eating and avoidance of seeking medical care. Bias among medical professionals is associated with lowered quality of care, including the harmful recommendation of weight loss (Puhl, R. & Heuer, C. 2010).
Clinicians in the medical field, as well as mental health practitioners, need to be aware of the inherent bias and outdated beliefs they may hold regarding body size and health. The general population would benefit from widespread awareness regarding the dangers of intentional weight loss and negative body image. Providers need to be familiar with Intuitive Eating and Health at Every Size and utilize these evidence-based approaches in their care of people of all sizes.
Body size does not dictate health or longevity, at least not in the way we’ve been made to believe. Even if there is a presence of disease, there is no evidence-based effective method of long-term weight loss. In the continual effort to “do no harm,” it is critical to understand that it is actually unethical to recommend weight loss.
Bacon, L., & Aphramor, L. (2011). Weight science: evaluating the evidence for a paradigm shift. Nutrition journal, 10, 9.
Campos P, Saguy A, Ernsberger P, Oliver E, Gaesser G. (2005) The epidemiology of overweight and obesity: public health crisis or moral panic? Int J Epidemiology, 35:55–60. doi: 10.1093/ije/dyi254.
Ingram D., Mussolino M. (2010). Weight loss from maximum body weight and mortality: the Third National Health and Nutrition Examination Survey Linked Mortality File. International Journal of Obesity, 34:1044–1050. doi: 10.1038/ijo.2010.41.
Mann T, Tomiyama AJ, Westling E, Lew AM, Samuels B, Chatman J. (2007). Medicare’s Search for Effective Obesity Treatments: Diets Are Not the Answer. American Psychology, 62:220–233. doi: 10.1037/0003-066X.62.3.220.
Puhl R, Heuer C. (2010). Obesity Stigma: Important Considerations for Public Health. American Journal of Public Health, 100:1019–1028. doi: 10.2105/AJPH.2009.159491.
About the Author:
Jennifer Pereira, LPC, RD, LD, is a Licensed Professional Counselor and a Registered Dietitian in private practice in Austin, TX. She has been working in the eating disorder field since 2005 in a variety of settings and levels of care. She is trained in EMDR and uses ACT and IFS approaches in therapy. She works from a Health at Every Size model and utilizes Intuitive Eating as her ultimate nutrition goal with clients.
The opinions and views of our guest contributors are shared to provide a broad perspective on eating disorders. These are not necessarily the views of Eating Disorder Hope, but an effort to offer a discussion of various issues by different concerned individuals.
We at Eating Disorder Hope understand that eating disorders result from a combination of environmental and genetic factors. If you or a loved one are suffering from an eating disorder, please know that there is hope for you, and seek immediate professional help.
Published February 21, 2020, on EatingDisorderHope.com
Reviewed & Approved on February 21, 2020, by Jacquelyn Ekern MS, LPC
The EatingDisorderHope.com editorial team comprises experienced writers, editors, and medical reviewers specializing in eating disorders, treatment, and mental and behavioral health.
