Thinking Beyond the Scale: A Case for Weight-Neutral Nutrition
One of the most common reasons people consult with a dietitian is for weight loss. This makes sense as a 2022 survey showed that 44% of respondents were currently dieting and 80% had dieted in the past[1]. While many start their weight loss journey to move towards health, many dieters end up as “repeat offenders”, starting and stopping diets with varying degrees of success. Long term, for most individuals about 95% of weight lost is regained within 5 years[2].
I say this all, not to beat you down so that you believe change is impossible, but so that you understand why I have moved away from recommending weight loss as the be-all-end-all solution for improved health. Ironically, in working with clients to care less about the number on the scale, we see the wheels begin to turn towards deep health. This alternative approach can feel unintuitive at first, but here’s why I think taking a weight-neutral perspective has potential to transform how you approach your health, food, body, and more.
Broadly speaking, we exist in a society that values different bodies, well, differently. This creates the underlying conditions in which we need to have these difficult conversations about weight and bodies. I want to be clear that I am not an expert in the sociocultural sphere, but try to learn from and amplify voices of those that are, especially due to my own limitations of experience. There is study of the intersection of weight bias and with other systems of oppression, including anti-blackness, misogyny, and ableism[3]. The belief that pursuit of thinness or an ideal body is something that everyone should be striving towards is colloquially known as Diet Culture. Diet Culture moralizes foods and creates rules that must be followed to achieve a “right” body. While a preference for thinness may feel innate, it is 100% worth questioning where this preference comes from, where you learned this, and who benefits from an unrelenting pursuit of thinness and health (also, note that when you’re hungry, that tends to be a brain’s primary focus). In your own lifetime, you have probably noticed that the idealized body type has shifted from rail thin to curvy, lean and toned, and back again, continually moving the goalpost of what’s considered desirable.
Anti-fat attitudes show up in our healthcare, education, and workplace, reinforcing internalized weight stereotypes and stigma[4]. What’s perhaps most impactful is how bias shows up in the health-related research and inappropriately links higher weight as a causative factor for illness and mortality without considering the impact of internalized weight stigma and shaming, including willingness to seek healthcare and the quality of care that individuals in larger bodies receive[5]; nor are the impacts of weight-cycling, weight suppression through dieting, and dieting history on health considered. This is perhaps why the intervention of weight loss continues to persist in the scientific literature and why we blame ourselves when we regain weight.
Because of this body of literature and presence of cultural bias, we land on the underlying assumption that one must exist within the narrow constraint of a “normal” BMI to be considered “healthy” and that all individuals above this range are unhealthy[6]. (let’s also keep in mind that the “normal” BMI category encompasses individuals with a BMI of 18.5-24.9 whereas the “overweight” and beyond categories are infinite so it would make sense that more incidences of disease are present in a much larger category). This also leads to the assumption that you can tell if someone is healthy by looking at them, and that health is entirely within an individual’s control (patently false, but outside the scope of this article). At the end of the day, health is individualized, personal, and complex- and even individuals who are not healthy deserve respect and compassionate care too.
In my personal and professional life, I believe it is important to challenge these existing systems of oppression and work to understand and uproot my own internalized biases. If I am not doing this work, I am doing a massive disservice to my community and the clients I work with. I can acknowledge that being in a more socially acceptable body does improve one’s sense of safety in society, but the work cannot end there. Though there is much that needs to change on a larger scale for true justice for all bodies, we can begin to separate our own values from the values of Diet Culture.
Intentions behind behaviors matter. If body image distress (in the context of Diet Culture) is driving the desire for change, we may need to hit the pause button. How could this be different if you met your own distress and discomfort and worked with it instead of responding reflexively with the next diet? This is how body image work shows up in practice and helps to weather the experience of being in a human body and the inevitable changes of aging, disability, and the uncertainty it entails. Fear being the sole motivator for change is rarely, if ever, a sustainable approach. I talk more about the shortcomings of acting on the impulse to fix here :).
Despite all of this, I am not “anti” weight loss. I am “anti” the belief that weight loss must happen for someone to see the benefits of health-seeking behaviors. Paradoxically, shifting focus away from weight as the only measured outcome often leads to the behavioral changes that folks desire to make and that impact health[7]. A weight-neutral approach is agnostic to changes in weight. I very rarely can predict how someone’s body will respond to adequate nourishment but I never doubt the wisdom of the body. I trust that bodies do what they need to do with consistent nourishment, even if the number on the scale doesn’t change (or goes down, or goes up).
These weight agnostic interventions are, as you may have already guessed, behaviorally focused. Through this lens, I see nutrition as a form of self-care that looks to treat your body with respect and tend to its needs, both physical and emotional. How you eat and the role that food plays in your life here matter. Most weight loss interventions do not look at the “dark side” of weight loss or even measure the all-too-common result of chronic dieting- erosion of body trust, rigid beliefs around food including excluding certain food groups or believing they are bad, obsessive or compulsive exercise to compensate for eating, or development of binge eating behaviors or body dysmorphia. Not so surprisingly, weight neutral approaches have lower risk of developing eating pathologies and have lower recidivism rates than a weight-normative approach[8].
What about the outcomes? I would argue that the greatest outcome of all is the process: becoming oriented towards growth. There are some other things to consider to broaden our perspective on health beyond weight, both objective and subjective. Perhaps how confident you are feeling around foods of all kinds and different eating situations, what your energy levels are throughout the day and during workouts, or mental focus and mood. Lab values, strength numbers, and sometimes body composition measures can also reflect a bigger picture of health vs. looking at the scale in isolation. We also can’t forget the interplay of social, relational, and mental health with physical health. Focus on nutrition needs to be a part of your life, but the cost is great when it takes up an enormous amount of time and mental energy.
Taking a weight neutral approach can feel radical when food and nourishment is so closely linked to weight in our society. But if you’re burned out chasing a goal weight and hoping the next diet is the “right one”, consider that the next diet might not be one at all.
[1] Study reveals Americans’ dieting habits in 2022. Within Health. https://withinhealth.com/explore-articles/study-reveals-americans-dieting-habits-in-2022#:~:text=Our%20survey%20finds%20almost%20half,of%20diet%20in%20the%20past.
[2] Wang, X., Lyles, M. F., You, T., Berry, M. J., Rejeski, W. J., & Nicklas, B. J. (2008). Weight regain is related to decreases in physical activity during weight loss. Medicine and science in sports and exercise, 40(10), 1781–1788. https://doi.org/10.1249/MSS.0b013e31817d8176
[3] Strings S. Fat as a floating signifier: race, weight, and femininity in the national imaginary. In: Boero N, Mason K, eds. The Oxford Handbook of the Sociology of Body and Embodiment. Oxford University Press; 2021:145-164. https://books.google.com/books?hl=en&lr=&id=W_kFEAAAQBAJ&oi=fnd&pg=PA145&ots=1lw0zpekdC&sig=Lxw07Lof__PEtRAXT6NERhNr2OM#v=onepage&q&f=false
[4] Giel, K. E., Thiel, A., Teufel, M., Mayer, J., & Zipfel, S. (2010). Weight bias in work settings - a qualitative review. Obesity facts, 3(1), 33–40. https://doi.org/10.1159/000276992
[5] Lee, J. A., & Pausé, C. J. (2016). Stigma in practice: Barriers to health for fat women. Frontiers in Psychology, 7. https://doi.org/10.3389/fpsyg.2016.02063
[6] Gutin I. (2018). In BMI We Trust: Reframing the Body Mass Index as a Measure of Health. Social theory & health : STH, 16(3), 256–271. https://doi.org/10.1057/s41285-017-0055-0
[7] Tylka, T. L., Annunziato, R. A., Burgard, D., Daníelsdóttir, S., Shuman, E., Davis, C., & Calogero, R. M. (2014). The weight-inclusive versus weight-normative approach to health: Evaluating the evidence for prioritizing well-being over weight loss. Journal of Obesity, 2014, 1–18. https://doi.org/10.1155/2014/983495
[8] Mensinger, J. L., Calogero, R. M., Stranges, S., & Tylka, T. L. (2016). A weight-neutral versus weight-loss approach for health promotion in women with high BMI: A randomized-controlled trial. Appetite, 105, 364–374. https://doi.org/10.1016/j.appet.2016.06.006
