What Is A Weight Neutral Approach to a Healthy Lifestyle?

By Dale Cooke Accredited Practicing Dietician

I’m sure you have heard he term weight neutral mentioned in relation to healthy lifestyle. Other common terms include a non-diet approach, eating mindfully or intuitively and Health At Every Size or HAES. Some health professionals are very passionate and committed to these approaches while others a little mystified and are wondering what it all means and how to implement it? 

What does it all mean? 

While these all have slightly different meanings they are all trying to: 

• reduce the burden of guilt associated with living in a larger body (note the terminology – I’m not saying overweight or obese) while encouraging your client to undertake healthy behaviours; and 
• to get you and your client to not focus on their weight and intentional weight loss when considering whether their lifestyle is healthy or not. 

Why?  

Because weight loss is not a behaviour. It is an outcome of many behaviours. 

We know that intentional weight loss doesn’t last, generally most people will regain their lost weight after 2-5 years. 

Most people can go on an intentional weight loss “diet” for a short time but due to the nature of most of these diets it’s really difficult to maintain them long term and so they will stop at some stage. There is an emotional consequence associated with this decision that can cause feelings of inadequacy, body shame, and a sense of failure. The general belief of health professionals and in the community is that people only fail to lose weight because they lack will power and discipline. And that makes people who stop their weight loss diets to have feelings of blame and shame. 

This weight cycling – also called yoyo dieting – also has negative outcomes for the body – our clients lose muscle and fat when they lose weight. When they regain weight they only gain fat, unless they are doing lots of resistance exercise. So, a person who yoyo diets can end up having a body composition higher in fat than before they lost weight. And that will increase their insulin resistance, making blood glucose management more difficult. 

So how do we measure our client’s lifestyle? 

How do you measure if your client’s lifestyle is healthy? Look at whether they are undertaking healthy behaviours. “What behaviours and why?”, I hear you ask – keep reading. 

Note that when clients do undertake healthy behaviours they might lose weight as a side effect. That’s good, but we still don’t want you or them to focus on the weight loss. Keep focussing on and encouraging them to do the healthy behaviours. So get your clients to totally separate the behaviours with the weight loss in their minds!  

Those healthy behaviours will have benefits for their blood glucose management, blood fats and cholesterol levels, blood pressure, mood, balance and strength, and quality of life – the benefits can’t be counted. 

Healthy behaviours 

Okay, what are these healthy behaviours and how will they improve health? They include: 

1. Eating healthy balanced meals – most of the time. By eating healthy balanced meals most of the time it means large amounts of high sugar/high saturated fat/high salt foods would not be chosen regularly, helping blood glucose levels and heart health. Your client’s food focus would be on eating fresh vegetables, fruit, fish, legumes, nuts, seeds, wholegrains, unsweetened dairy foods or alternatives, and small amounts of lean chicken and meat, unsaturated fats. It doesn’t mean they can’t have small amounts of sugary/fatty/salty foods, but that they remain as ‘sometimes and in small amounts’ foods. 
2. Having a positive relationship with food. This means your clients are less likely to binge eat on foods as no foods are restricted. There’s less guilt and less psychological stress if they do enjoy ‘sometimes and in small amounts’ foods. And by not moralizing food as ‘good’ and ‘bad’ but rather being curious and observing how food and situations affect them physically and mentally they nourish their bodies. 
3. Doing regular exercise. This will help manage their blood glucose levels, reduce LDL cholesterol and increase HDL cholesterol, as well as improve their overall fitness, strength, flexibility, and balance. And it’s great for their mood. 
4. Getting enough sleep. As this helps your clients to be more energetic during the day – so they’ll feel more like doing some of the other health behaviours than if they are tired and cranky. 
5. Managing their stress proactively. This might mean seeing a psychologist for strategies to manage situations or doing daily meditation or whatever works for them. As you know, blood glucose levels are increased with stress so with less stress their blood glucose levels are better managed, they are more likely to sleep better, and, again, engage in other healthy behaviours. 
6. Taking their medication as prescribed by their GP or specialist so their health conditions, including diabetes, will be better managed. 
7. And by seeing their health team regularly – including you. It allows them to bring up any concerns in a timely manner and have treatments for anything that pops up, as well as have questions answered that might otherwise cause stress or anxiety. 

Remember, we should be trying to provide person centred care. I would encourage you to try this weight neutral approach with your clients and see if it resonates with them. Encourage your clients to return to you and feedback on whether the approach is working. If it isn’t then discuss alternative management philosophies. 

Where to go for more information 

There’s lots of information out there,  you just have to take some time to consider how you might implement it with your clients. If you are new to these concepts it may take a while to feel comfortable with them. 

Websites: 

• Fiona Willer, www.healthnotdiets.com   
• Fiona Sutherland (DUD Day speaker), www.themindfuldietitian.com.au  
• Association for Size Diversity and Health, www.sizediversityandhealth.org  
• Megrette Fletcher, RD/ CDE, www.megrette.com 
• Dances with fat: What to say at the Doctor’s office: https://danceswithfat.wordpress.com/2013/04/01/what-to-say-at-the-doctors-office/   

Publications: 

• Weight science: evaluating the evidence for a paradigm shift (Bacon, 2011) 
• The Non-Diet Approach for Dietitians Handbooks  
• “Impact of Non-Diet Approaches on Attitudes, behaviours and health outcomes: A Systematic Review” (Clifford, Dawn et al., 2015)  
• The weight-inclusive versus weight-normative approach to health: evaluating the evidence for prioritising well-being over weight loss (Tracy Tylka et al., 2014) 
• Does it really matter? Weight and values in public health. (Jutel 2001)
• Obesity paradoxes (McCauley and Blair, 2011) 

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