Weight-inclusive health care means a focus on better health with no weight loss required.
This includes practices such as eating for overall well-being rather than for the number of calories. It may also include prioritizing activities to reduce stress, avoiding smoking, drinking less alcohol and striving to be physically active in enjoyable ways.
A weight-inclusive approach to health seeks to undo the harms caused by weight stigma.
People with larger bodies often experience weight stigma as discrimination, prejudice, negative stereotypes and judgments from others – including their own doctors and other health care providers. More than 40% of U.S. adults across a range of body sizes report experiencing weight stigma in their day-to-day lives.
Avoiding this stigma is likely a major driver behind the great lengths people in the U.S. go to in order to lose weight. Market data shows that Americans spent some US$72.6 billion on weight loss products and programs in 2021. In addition, weight loss efforts start early, with nearly half of all high school students in the U.S. reporting that they have tried to lose weight.
I am a nutrition epidemiologist and registered dietitian studying the consequences of weight stigma and working to develop weight-inclusive nutrition interventions.
Initially my private practice and research approach were weight-centered. A weight-centered approach focuses on weight loss to achieve health and is widely accepted in health care settings across the world. After over a decade of work in public health nutrition, I have witnessed how, in my view, the weight-centered approach harms individuals and communities. So I have shifted to using a weight-inclusive approach in practice and research.
Overturning the ‘lower weight equals better health’ dogma
There is an extensive body of research and public health messaging indicating that higher body weight has links with many long-term health concerns, such as high blood pressure and Type 2 diabetes.
As a result, there is a pervasive misconception that a weight-inclusive approach disregards the patient’s health concerns. However, proponents of weight-inclusive care argue that a weight-inclusive approach minimizes health problems by destigmatizing weight status and promoting health equity. They also acknowledge that there are links between both higher and lower body weight and various health concerns.
The dogma that lower weight is synonymous with better health is being questioned by public health researchers and health care providers. Scientists and clinicians are calling for a paradigm shift away from a weight-centered focus on weight status and body mass index, or BMI, as indicators of health.
Advocacy groups like the Association for Size Diversity and Health have long been promoting the Health at Every Size approach. This weight-inclusive approach affirms a socially just definition of health and advocates for equitable health care regardless of weight status. More recently, the American Medical Association released a statement outlining the harms and shortcomings of using BMI as a clinical measurement.
The evidence supporting weight-inclusive care
Substantial research shows that behaviors such as stopping smoking and drinking less alcohol can prevent disease and support overall long-term health, regardless of body weight. For example, a systematic review of one clinical trial and 152 observational peer-reviewed studies reported that a diet high in nutrient-rich foods with low or moderate alcohol consumption is associated with reduced risk of death for everyone.
Another example: One of my own clients with high cholesterol said that focusing on weight loss over their lifetime had left them stuck in a cycle of weight loss and weight regain, disordered eating, inconsistent and extreme exercise habits and body image concerns. After adopting weight-inclusive practices such as eating more fiber-rich foods and being more physically active, instead of focusing on losing weight, their cholesterol levels returned to normal.
Both the weight-inclusive approach and the weight-centered approach can include diet changes, increasing physical activity and reducing stress as key components to manage and prevent diseases. However, the weight-inclusive approach works to end weight stigma and acknowledges that factors such as socioeconomic status, culture and access to food and health care – collectively called the social determinants of health – have huge impacts on a person’s body weight, shape and size. Even if a person could adhere to strict dieting and exercise routines, there will always be structural, political and other factors affecting health and weight that the individual can’t control.
What’s more, evidence indicates that people who lose weight generally don’t have better long-term health and fail to keep those pounds off.
Finding weight-inclusive health care
There are several things that people can look for in a weight-inclusive health care practice.
Look for health care providers who:
- Make weight checks optional for routine visits.
- Treat patient symptoms rather than telling them to lose weight.
- Provide patients in larger bodies the same treatment as those in thinner bodies with similar health concerns.
- Use measures other than BMI, such as lab results, to diagnose health concerns.
- Ask permission before discussing weight with patients.
For additional resources on weight-inclusive care, check out the Health at Every Size Health Sheets. Consider examining your own weight bias by taking an online test focused on implicit associations around weight.
Lauren Butler is Assistant Professor of Nutrition, Texas State University.
The Conversation is an independent and nonprofit source of news, analysis and commentary from academic experts.
© The Conversation
19 Comments
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Wick's pencil
Weight-inclusive health care means: addressing (and profiting from) the symptoms while ignoring the underlying cause of the health issues.
virusrex
As the article makes painfully clear this is not the case. Did you even read it?
Wick's pencil
You mean like: "Treat patient symptoms rather than telling them to lose weight."
Did you even read it?
Moderator
No bickering please.
virusrex
Your quote do NOT support your flawed misinterpretation of the text it never says causes of the disease are to be ignored instead addressed differently, many other parts of the text explicitly contradict it, for example:
None of this is just about treating symptoms while ignoring causes as you said, the only barely acceptable explanation to making a misrepresentation as you did was that you did not read the article, if you did and still choose to misrepresent it that means you are accepting you were trying to mislead people on purpose.
virusrex
What makes you think she is not following her own advice? for all you know the professional is doing exactly what the article is talking about. Addressing the direct causes of health risks instead of solely focusing on weight is what the article is talking about.
But even if that was not the case, the evidence included is still enough to disprove your own personal opinion about it, do you think a pneumologists would be lying when telling you to stop smoking just because he also does it?
The difference is that you like to think having a personal opinion that is not supported by evidence is enough to refute one that does have it, and when called to address this unethical position insist that you know better than the professionals instead of actually addressing the arguments and evidence available.
Making up imaginary claims about other commenters is another sign you are not interested in actually discussing the article, just attack people when they can prove you have no arguments to refute the article you are commenting on.
Skeptical
I frankly had never heard of ASDAH before.
But ProPublicia has posted on their website a Form 990 reportedly from them, that reflects the following mission statement for EIN 30-0368265:
Okay. How?
Form 990 4(a) tells us that the organization:
From the starting gate, patients are responsible for their own health care. And partners in reasonable medical decision making. I sincerely believe that most providers want / need / encourage their patients to be engaging in their care. Encouraged to do their own research, to write down questions and concerns before their appointment, to send such in advance, and to engage their provider in helping to devise a care plan suited to their individual needs. And to seek second and third opinions when desired.
That said, the patient should respect the provider’s training and experience. And their desire to help engineer quality care to all patients. And if the patient feels a provider isn’t giving the advice and care they desire, they should feel free to seek the advice of another care provider, that they may have more confidence in.
As to some of the points at the end?
To make weight checks optional for routine visits? And to treat symptoms rather than telling them to lose weight?
Not advisable. Since many medications are dosed according to weight. Be it Total Body Weight, Lean Body Weight, and / or Ideal Body Weight. Many practitioners will tell you that drug clearance is greater in obesity cases, and that chronic dosing using body weight can lead to drug toxicity. Plus calculating maintenance doses based on total body weight often will not have comparable drug response across different body sizes, and can increase the risk of adverse events. But it takes experience to apply some of these practices. To bind a practitioners hands in not having a current weight when prescribing or recommending is asking for trouble. And could be considered malpractice in the making.
And to treat symptoms rather than recommending and applying preventitative measures and alternative suggestions, to avoid disease and / or to minimize the impact of disease on overall health, would be a total disservice, and could mean both substandard care and may be nonfeasance. Plus some wasted time and resources on everyone's part.
virusrex
Routine visits would mean the weight variation is not enough to merit a change in dose, which is extremely common. Of course a doctor is still in charge and if he noticed a need to weight the patient for the purpose of adjusting a dose that would make it still inside of the recommendation given.
Also, the recommendation is not to treat symptoms instead of addressing causes or minimize the impact of disease, it is instead of telling them to lose weight, this is a very specific recommendation being given that is not being generalized as if it replaced everything else that is done during a medical visit only one single action. Doctors can still address the cause of the symptoms, can still do a lot of things (including medication) to reduce the risk.
the_sicilian
So from the above Form 990:
What does an "activist" have to do with respect to healthcare? This is more liberal nonsense. If someone is overweight, then a doctor or PA (or the equivalent should prescribe the recommended care that is medically necessary. That would be the proper approach, and telling the patient what they need to do.
Skeptical
Routine visit implies an annual / regularly scheduled wellness check or routine physical exam. It can be a misnomer for this discussion, depending on if you have seen a patient before, or if it is a return visit, that is necessary for monitoring chronic or reoccurring disease processes, along with previously prescribed medications and certain specific lab levels. If a continuing patient is asymptomatic and is not on a medication requiring adjustments or alternative therapies and /or life-style approaches, and is not being monitored post-injury or post-operative, or otherwise not in a high risk cat, then I would tend to agree that weight variation would not, by itself, require weigh-in or further discussions.
Routine visit, as stated above, in an asymptomatic patient? Since the patient was last seen (by anyone), has there been substantive changes in the field of medicine which recommendations may be unique / beneficial to that patient? Acceptable approach would inform the patient of the trends and recommendations, and inform as to what the patient can watch for in the way of future symptoms or complaints of decreased functionality or quality of life.
One can educate and inform in a just, compassionate and professional manner without stigmatizing or discriminating.
virusrex
Exactly, this is a very good way to make a concise point about the article, it is not about replacing or reducing the amount of medical attention the patients receive because of their preferences, but adequating the attention so the patients can still feel accepted and can work positively towards their own health care in the most effective way.
Raw Beer
Wasn't there, not that long ago, a very similar article here on JT?
Exactly!
virusrex
The article clearly disproves this misrepresentation, there is absolutely no call to ignore underlying cause of health issues, this becomes clear when you were unable to refute this argument with any of your own, clearly recognizing the claim is disproved in the text.
wallace
1 kg weight gain over the New Year. Back to the gym tomorrow. During my three monthly hospital visits, my weight is always taken.
Raw Beer
Wick's pencil quoted directly from the article to prove his point ("Treat patient symptoms rather than telling them to lose weight"). If you disagree, fine; just state your opinion, no need to, as you always do, tell people that they are wrong or misrepresenting.
virusrex
And it still does absolutely nothing to prove the mischaracterization he tried to make, not focusing exclusively on making the patients lose weight is completely different from not treating the many different causes of their health problems, as proved completely by the quoted text that still disprove the point, quotes that you made no effort trying to rebuke, thus conceding that they do refute it. It is not that I don't agree, is that the article clearly and explicitly make this misrepresentation false.
Not a single argument to refute the point would mean I am not the one falling to read the article.
zibala
Good luck to this approach, which would be in kine with what the experts advocate as the best approach at maintaining a healthy weight which is by exercising and controlling caloric intake so as not to be excessive.
virusrex
The article explicitly contradicts your comment, according to this approach maintaining a healthy weight should no longer be the huge priority on medical visits since it brings no benefit while reducing the quality of the medical attention. Do you have any evidence that the article is wrong? because if not contradicting it has no real weight.
Elvis is here
Generally speaking, every 1kg of weight gain needs about 7000 additional calories. That's is a lot of Peking Duck