A Weight-Neutral Approach to Healthcare, Explained.
At Lauren Cornell Nutrition, our dietitians practice with a weight-inclusive model and support people of all sizes in finding compassionate ways to take care of themselves. This post explains our weight-inclusive, or weight-neutral, approach more in detail so that you may find a registered dietitian who aligns with your values.
What does it mean to have a weight-inclusive approach?
A weight-inclusive, or weight-neutral, approach to healthcare leaves behind the antiquated falsehood that weight or a body mass index (BMI) are accurate determinants for health and instead focuses on evidence-based biomarkers to assess wellbeing. Practicing with a weight-inclusive model means rejecting the assumption that our health is directly related to our physical size or a number on the scale and instead, encouraging our patients to focus on making healthy changes for reasons related to wellbeing and feeling better (e.g., reducing symptoms, having more energy, etc.) as well as improving biomarkers of health (e.g., lowering blood sugar and cholesterol levels), regardless of outcomes that may influence weight. While we do not ignore a person’s anthropometric measurements (height, weight and weight history, body composition, etc.) and certainly investigate any abnormal deviations from a person’s typical trends in these metrics, the number on the scale often plays an insignificant role in conversations with our patients when it comes to evaluating results and progress.
Health is complex and dynamic, and it encompasses a number of determining factors such as genetics, environment, socioeconomic status, diet & lifestyle, trauma history, and resources to name a few. To provide our patients with the most accurate and comprehensive care, we consider all of the factors influencing a person’s health.
Through weight-inclusivity, we appreciate all body types, shapes, and sizes. We encourage our patients to celebrate their bodies, enjoy food, and look forward to exercise. We do so by embodying self-compassion and empowering our patients to practice the same compassion for themselves.
The Science Behind A Weight-Neutral Approach
Large bodies of research have acknowledged that there are links between both higher and lower body weight and various health concerns, and sometimes no association at all between body size and health status. Thus, the belief that lower weight equal better health is being questioned by researchers and health care providers. Scientists and clinicians are calling for a paradigm shift away from a focus on BMI and weight status as indicators of health.
Healthcare practitioners have taken an oath to “do no harm”, and weight-inclusivity is a harm reduction approach to healthcare that seeks to avoid the damage that dieting, fat phobia, and weight stigmas cause. Shifting the focus away from body weight and more towards healthy behaviors has also proven to result in more positive, sustainable outcomes for patients. On top of that, providers focused primarily on weight as an indicator for health may overlook underlying health problems that patients have for other reasons unrelated to weight. Likewise, providers may be less inclined to screen patients with BMIs in the ‘normal’ range for health conditions even when they are exhibiting symptoms [1].
A statistic of note in support of weight-neutrality in healthcare is that individuals in the ‘overweight’ BMI category have been proven to outlive those of ‘normal’ weight and other BMI categories [2].
Additionally, so many factors influence weight that have nothing to do with a person’s efforts or intentional choices, which proves the weight on the scale to be an unreliable marker for progress.
The Importance of a Weight-INCLUSIVE Approach
We at Lauren Cornell Nutrition believe in providing nutrition services through an equitable and compassionate lens that allows for each individual that we treat to feel heard and advocated for. A weight-inclusive approach is also a social justice approach that brings awareness to size diversity and rejects weight discrimination, generally and across different cultures that include people of all shapes and sizes.
Practitioners that subscribe to the notion that achieving a ‘normal weight’ is necessary for health encourage diet culture behaviors to help people lose weight, but if recommended to a slender person, these same behaviors would be diagnosed as disordered eating [3]. The weight-inclusive paradigm recognizes this flawed method and removes weight from the care process as a metric to strive for.
A weight-neutral approach also removes the barriers to healthcare created by the negative implications of weight-focused health interventions. Aside from disordered eating, people subject to weight-focused healthcare often adopt poor body image, avoid doctors, and may experience weight gain as a boomerang effect [4, 5]. Individuals with lower or higher body weight may delay seeking health care to avoid feeling weight shamed or avoid receiving unsolicited advice to lose or gain weight from their practitioners [5]. Practitioners adopting a weight-neutral paradigm in their method of care help to move away from these negative effects, allowing patients to feel more comfortable and accepted in their medical appointments and helping to improve their perception of healthcare through a more positive experience.
Also, when weight loss - a factor influenced by so many uncontrollable variables - is no longer a goal, the individual is able to then focus on creating and maintaining healthy behaviors, which is far more successful in achieving sustainable wellbeing. The feeling of failure when weight loss is not achieved when it remains a goal can deter a person’s journey to realizing their greatest health, and feeling the best we’ve ever felt is the ultimate goal [6].
How We Practice A Weight-Neutral Approach
Our objective is to help you build sustainable healthy behaviors that allow you to feel your absolute best, both physically and mentally. And we do so in a way that celebrates who you are while empowering you with education, compassion, and identification of your intrinsic and extrinsic motivators. As evidence-based practitioners, we incorporate medical biomarkers and intuitive eating in our processes.
Personalized goals + plan
Following our patient-centered care philosophy, we work with you to create a definition of health that aligns with your personal values. Once your health outcomes are clearly defined, we then then help you to create S.M.A.R.T. goals linked to evidence-based metrics such as improved lab test results, energy levels, or cardiovascular endurance that we’ll use to assess our progress towards achieving your best health. We’ll continue to check in with you to ensure that the goals align with what feels sustainable and right for you.
FOCUS ON SELF-AWARENESS
We’ll help you to hone your body’s own cues, as our system’s built-in “alerts” are our best gauge for health. We’ll direct your attention to what is happening within your body when your health behaviors improve (e.g., improved mood, better stamina when being physically active, reduced gastrointestinal issues) rather than changes to your appearance.
ENCOURAGING INTUITIVE EATING
There is a lot of noise in the world about what, when, and how much we should eat. The truth is that the right way to eat differs for each of us, and our bodies serve as our own personal guides in best understanding what our unique needs are. Sometimes medications, health issues, changes in lifecycles, and life’s stressors can cloud our interpretation of what our body is trying to tell us, which can make ‘intuitive eating’ feel like we’re being thrown into the deep end to fend for ourselves. We’re here to help set the record straight and assist you in confidently understanding your body’s unique nutritional needs.
inspiring enjoyable movement
The benefits of exercise are vast, yet sometimes physical activity can feel like a chore. Let us help you find movement that you look forward to doing that allows you moments of your day when you can get out of your head and into our body for some you time.
coordination of like-minded care
When needed, we aim to refer our patients to other health professionals and specialists who share a weight-inclusive approach. We also advocate for our patients when communicating with other members of their care team on the importance of maintaining a weight-inclusive paradigm across all aspects of the patients’ healthcare experience.
weight shouldn’t be the elephant in the room
By adopting a weight-neutral approach to healthcare, we certainly do not ignore weight. Body weight is a measurement that is - and always will be - a topic of conversation and something we will consider, though it is not a staple in our practice or your care plan because we simply don’t need it to be. Yes, evaluating weight history & trends is a part of our assessment as dietitians and a piece of your health story. But weight is not the main event, nor does it usually need to be a significant player in your healthcare journey.
That said, it’s okay to question why our bodies change (or don’t change) or to desire changes in our body size. We’re here to have those conversations with you and understand that thoughts surrounding weight don’t just vanish, even when we adopt health goals outside of weight loss. We are here to support positive personal growth and walk alongside our patients in their journeys toward better health, which includes challenging ingrained beliefs and having difficult conversations.
A WEIGHT-NEUTRAL APPROACH FOR ATHLETES
The results-based world of sports can promote a lot of pressure for athletes to adhere to a certain body type or body size, depending on their sport, position, or performance expectations. As dietitians specializing in sports & performance nutrition at Lauren Cornell Nutrition, we are aware of the heightened weight stigma in sports and hold space for conversations surrounding the pressures that our athletes endure in this area.
We have always focused on body composition measurements outside of weight that paint a more accurate picture of an athlete’s progress in efforts to optimize performance. And with more and more professional athletes breaking the molds for body size & type in various sports, the understanding that performance greatness is not linked to body weight is being realized more and more. Rest assured, the objective with our athletes is always to optimize performance, reduce recovery time & risk for injury, and best manage symptoms all through the least restrictive diet possible, which is easily achieved without using weight as a metric.
Find more information here about working with one of our weight-inclusive dietitians.
References
Sole-Smith, V. (2020). Treating patients without the scale. Scientific American, 23–31. scientificamerican.com/magazine/sa
Visaria, A., & Setoguchi, S. (2023). Body mass index and all-cause mortality in a 21st century U.S. population: A National Health Interview Survey analysis. PloS one, 18(7), e0287218. https://doi.org/10.1371/journal.pone.0287218
National Eating Disorders Association. Moving from weight neutral to body affirming.
Bessey M, Lordly D. Weight Inclusive Practice: Shifting the Focus from Weight to Social Justice. Can J Diet Pract Res. 2020;81(3):127-131. doi:10.3148/cjdpr-2019-034
Mensinger, J. L., Tylka, T. L., & Calamari, M. E. (2018). Mechanisms underlying weight status and healthcare avoidance in women: A study of weight stigma, body-related shame and guilt, and healthcare stress. Body Image, 25, 139–147. https://doi.org/10.1016/j.bodyim.2018.03.001
Bacon, L., Stern, J. S., Van Loan, M. D., & Keim, N. L. (2005). Size Acceptance and Intuitive Eating Improve Health for Obese, Female Chronic Dieters. Journal of the American Dietetic Association, 105, 929–936. https://doi.org/10.1016/j.jada.2005.03.011