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Blog: Challenging Our Current Weight-Focused Paradigm: Considering Health at Every Size

Watch for a new CON-SNP blog space coming soon!

By Eva Pila (Chapter Rep, University of Toronto)

In recent years, CON has made addressing and reducing obesity bias a priority. Weight bias and stigma refer to negative attitudes, preconceptions, and behaviours that negatively impact individuals. Weight bias and stigma comes in many different forms – including verbal (e.g., weight-related teasing or ascribing negative stereotypes based on weight), and physical weight-related barriers and obstacles (e.g., lack of appropriate chairs or seats to accommodate larger bodies).

Extreme stigma can result in discrimination – such as a qualified professional being denied a work position or promotion due to perceived weight. This weight-based judgment and stereotyping is highly problematic and contributes to a wide range of consequences, including:

  • Psychological concerns like depression, anxiety, and body image disturbance;
  • Social concerns such as exclusion, isolation, and inequality;
  • Physical concerns like physiological stress; and
  • Socioeconomic consequences such as inadequate access to healthcare and barriers to treatment.

Many factors contribute to the highly prevalent stigmatization of obesity – including a societal focus on weight loss and medical communities that utilize solely weight-focused approaches to obesity management. Recognition of our current problematic weight-focused paradigm has urged the development of compassionate approaches in obesity care and management.

Drawing from research and clinical practice in eating disorders and obesity comes an interdisciplinary movement called Health at Every Size™ (HAES). The focus of HAES is to shift from weight management to health promotion and support health behaviours without any focus on weight outcomes.    The HAES paradigm differs from traditional models by emphasizing self-acceptance and health behaviours. According to creator Dr. Linda Bacon, HAES "acknowledges that good health can best be realized independent from considerations of size. It supports people—of all sizes—in addressing health directly by adopting healthy behaviors."

HAES is defined by five main principles:

  1. Promoting physical and psychological health and well-being without focusing on changing weight.
  2. Accepting body diversity in self and others.
  3. Eating mindfully and intuitively by nourishing body with food that meets individual nutritional needs and based on internal cues of hunger and satiety.
  4. Enjoying physical movement that promotes physical and psychological health.
  5. Challenging weight bias and stigma and recognizing that body appearance and weight are not exclusively linked with particular ways of eating or exercising.

The key message of HAES is disentangling health behaviours from pursuits to change weight. Some of the controversy around HAES stems from the misconception that any weight is healthy by definition – rather HAES suggests that individuals can be healthy at any weight if they also prescribe to self-care practices like eating mindfully and engaging in movement that is enjoyable.

In fact, there is a growing body of randomized controlled trials showing robust associations between the HAES approach and significant improvements in metabolic markers, health behaviour and psychosocial well-being outcomes.

Adopting this weight-neutral approach may seem radical and contrary to the current overarching conceptualizations of weight across health communities. While still recognizing that obesity and weight management are highly complex issues, considering alternate paradigms may be just what we need to reduce the existing and pervasive weight bias, stigma and discrimination.  

As CON-SNPs, young researchers and practitioners, I encourage you to:

  1. Consider weight stigma and bias within our social culture where weight loss is popularly pursued, and restrictive and regimented health behaviours are idealized.
  2. Challenge traditional paradigms, consider the prevailing issues with our current systems of weight management and become mindful of alternative approaches to conceptualizing weight.
  3. Challenge the pursuit of weight loss and critically consider that how and why we engage in health behaviours is equally important as engagement in the first place. 

What are your thoughts on alternative paradigms to weight management and health promotion? Share them with us!

References


Bacon, L., & Aphramor, L. (2011). Weight science: evaluating the evidence for a paradigm shift. Nutrition Journal10, 2-13.

Provencher, V., Bégin, C., Tremblay, A., Mongeau, L., Corneau, L., Dodin, S., ... & Lemieux, S. (2009). Health-at-every-size and eating behaviors: 1-year follow-up results of a size acceptance intervention. Journal of the American Dietetic Association109, 1854-1861.

Provencher, V., Bégin, C., Tremblay, A., Mongeau, L., Boivin, S., & Lemieux, S. (2007). Short‐Term Effects of a “Health‐At‐Every‐Size” Approach on Eating Behaviors and Appetite Ratings. Obesity15, 957-966.

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 Association105, 929-936.

Gagnon-Girouard, M. P., Bégin, C., Provencher, V., Tremblay, A., Mongeau, L., Boivin, S., & Lemieux, S. (2010). Psychological impact of a “Health-at-Every-Size” intervention on weight-preoccupied overweight/obese women. Journal of Obesity1-12.