Practicing Weight Neutrality in a Weight-Biased Healthcare System
In recent years, our society has become more open and understanding regarding peoples’ differences, but it seems weight is one area in which our culture has miserably failed to become more accepting. When it comes to size and weight, people continue to be judged against unrealistic and arbitrary ideals. Where is weight neutrality in this picture?
Too often, larger people are criticized, shamed, and misunderstood because of their weight. Furthermore, the perception of many healthcare providers remains that “if people would just lose weight, they could be healthy.”
Where’s the weight neutrality?
How ridiculous it is to think we can begin our lives with entirely different sets of genetics and end up looking the same or staying healthy at unnatural weights for our bodies!
Non-diet dietitians are already like fish swimming upstream in a river of 61-billion dollars-worth of diets, and the current becomes even stronger when practicing weight neutrality, especially when serving as the only weight neutral provider on an interdisciplinary team.
For several months, I worked with a woman (we’ll call her Beth) whose goal was to manage her diabetes, blood pressure, and cholesterol. She wanted to be healthy and to live longer, and she initially assumed the way to do so was through dieting. Our first sessions were spent reviewing and discussing research about diets versus intuitive eating, and Beth emphatically vowed, “I’m definitely not going back to dieting EVER!!!” stating she loved the newfound freedom she had with eating.
Eating intuitively, moving mindfully
In the meantime, through learning to eat intuitively and incorporate movement mindfully, Beth managed to cut her triglycerides in half and bring her cholesterol down to a normal range. She gained incredible insight into her relationship with food and recognized how satisfied she felt when she ate healthy AND tasty foods.
Giving up the scale
But there was one major challenge she continued to face: giving up the scale. After much discussion, Beth recognized how the scale was blinding her to the progress she was making toward health. She reluctantly agreed to put the scale in the attic for a while and contact me if she felt the urge to weigh herself.
Changing the view of progress
Beth acknowledged her need to change her view of progress. She began to accept the possibility (which was becoming a reality) of being healthy in a larger body and to recognize that her size did not change her worth and value in life.
She moved away from…
Focusing on a number on the scale that she could not directly control
Focusing on weight first and foremost
Asking: “How many pounds did I lose?”
Questioning: “How do I look?”
Priding herself on having good willpower or self-control
She moved toward…
Focusing on behaviors that lead to health
Concentrating on actions she could control
Noticing her increased trust in herself with food
Questioning: “How do I feel?”
Priding herself on recognizing inner body cues
(Adapted from Intuitive Eating, Evelyn Tribole & Elyse Resch, 2003/2012)
At her next check-up with her primary care physician, the first topic addressed related to weight loss. The physician praised Beth, exclaiming, ”You’ve lost 9 pounds!” Immediately, her mind wandered back to the number she originally had in mind that might make her “healthy” again.
Already feeling ashamed and discouraged, Beth hesitantly told her doctor, “I’ve been feeling exhausted lately.” Her physician responded by stating, “You’re still carrying around lots of extra weight. Imagine carrying around your 10-year-old son all day. You’d feel exhausted, wouldn’t you? That extra weight is keeping you tired!”
Validate the patient’s concerns
In one conversation, Beth’s physician not only fueled her recent fantasy of weight loss as a magic bullet to solve her health problems, she also failed to validate her patient’s concerns. Rather than taking inventory of the lifestyle, psychological, or medical conditions that could be causing her fatigue and offering a plan of care to reach the root of the problem, she gave the simplistic answer: “Lose weight.”
Make evidence-based recommendations
According to the research, 97 percent of diets fail, and most people regain their lost weight in 1-5 years (Puhl, 2008). Combine dieting and weight cycling, and you have a recipe for a physical and emotional health disaster.
Leslie Schilling, MA, RDN, CSSD, LDN puts it this way: “If you were prescribed a drug with such a high failure rate, would you fill the prescription?”
People trust their providers to administer quality, evidence-based care; however, when they receive different messages from different providers, how do they know whom to trust?
It’s time all health professionals learn that the number on the scale does not define a person’s health, worth, or value. Our patients are human beings, not human bodies, and they deserve evidence-based guidance, rather than judgment, shame, or “easy answers.”
Equip people to advocate for themselves
Perhaps as you read about Beth’s experience, you felt anger, sadness, and frustration bubbling up. It is my hope that the feelings you experience throughout Weight Stigma Awareness Week will be used as fuel to begin to educate other providers and equip those with whom you come in contact to advocate for themselves.
Ignoring weight bias does not increase awareness or lead to change, but here are some practices that can:
Derail “fat talk” or weight-biased conversations and deflect them using research to support your case.
Engage in body activism and encourage body acceptance.
Focus on functionality versus appearance in your practice.
Listen to your patients and seek to validate their concerns.
And remember to start with yourself. Examine yourself, looking for weight bias in your own life. Though the previous case study only addressed weight bias from a physician, I think we’ve all been taught or heard ideas that perpetuate weight stigma in our training. I know I have.
Practice weight neutrality
As providers, let’s stop believing that differences in weight and size define a patient’s health or worthiness of quality care. Let’s practice weight neutrality. Continue to remove weight stigma and bias in the provider community by changing the view of progress, validating the patient’s concerns, making evidence-based recommendations, and equipping professionals with knowledge and people to advocate for themselves.
It was an honor to contribute this post to
Binge Eating Disorder Association's Weight Stigma Awareness Week 2015. See the original blog post here.
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