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When you first learned of intuitive eating or an anti-diet approach to nutrition, what did you hear?
For many people, “not pursuing weight loss” tends to rank high on that list. But a weight-inclusive approach is a lot more involved — and has a lot more to offer! — than that. If you’re new to this world, a weight-inclusive — sometimes referred to as a weight-neutral or size-inclusive approach — emerged out of fat activism in the 60s. Lew Louderback wrote an article (“More People Should Be Fat!”) in response to the poor and fat phobic medical treatment his wife endured, which appeared in the Saturday Evening Post. In it, he argued that fat folks suffer both physically and emotionally from weight suppression (getting below their set-point weight); intentional changes to weight are likely temporary and cause physical and emotional damage; dieting is psychologically detrimental; and weight can be maintained or managed by simply listening to hunger and fullness cues (to the best of a person’s ability.)
Various books arguing the benefits of not dieting and on the topic of intuitive eating were subsequently published. Health at Every Size as we know it today and the weight-inclusive approach originate with this grassroots activism. At its core, HAES and weight-inclusivity is intricately tied to social justice efforts to centre underrepresented people, particularly fat people, and exists to advocate for inclusive policy changes. As a white, cisgender, and thin woman, I can’t speak on behalf of the entire movement, but here’s my best shot at exploring some of the ways nutrition practitioners (such as yours truly) differ in approach from weight-normative or weight loss practitioners.
If you’re looking for a sound bite:
a) A weight-inclusive approach supports the pursuit of health habits and behaviours, like drinking water or eating vegetables, for their own sake, rather than as a means to lose weight (which falls under dieting.)
b) A weight-inclusive approach cannot be divorced from its social justice roots
c) Most importantly, a weight-inclusive approach and a weight-centric approach reflect two completely different paradigms with two completely different perspectives on health, and can never be safely or ethically used in conjunction with one another.
But how does this translate to nutrition practice, and what’s it like to work with a weight-inclusive practitioner?
1. We usually ask questions rather than dispense advice. This is one of the biggest distinctions between a weight-centric and a weight-inclusive approach. Most (if not all) of the certified intuitive eating counsellors and anti-diet professionals I know invest a lot of time and energy into learning and strengthening their counselling skills to elicit transformation in their clients. Our approach is process-driven versus content-heavy, which means change is typically slow (but steady and sustainable), collaborative, and client-centred. For this reason, many refer to the work as “nutrition therapy.” Depending on the practitioner, we might draw on elements of mindfulness and self-compassion, Motivational Interviewing, Acceptance and Commitment Therapy (ACT), Internal Family Systems, Emotion Focused Therapy/attachment science, Dialectical Behavioural Therapy, Cognitive Behavioural Therapy, Solutions-Focused Therapy, Somatic Therapy, and more. Many intuitive eating counsellors and body image coaches have professional coaching training.
2. We believe weight stigma is more harmful than being at a higher weight — that fat hate is worse for someone’s health than actually being fat. So no, we don’t offer or endorse the intentional pursuit of weight loss, which has been shown to perpetuate weight stigma, contribute to disordered eating behaviours and the development of clinical eating disorders, and worsens body image. Instead of using weight loss as a tool for improved health, we help our clients to foster health habits and behaviours. Remember that people of all sizes and shapes get chronic diseases.
Weight-inclusive providers generally subscribe to the concept of natural weight and set-point theory—that there is a range your body will fight to stay within regardless of your effort to manipulate it— and believe in a natural diversity of shapes and sizes. We recognize that intentional weight loss efforts do not support health outcomes —habits and behaviours are largely responsible for that— and at times can make things worse. The truth is, while individual habits and behaviours are important, a lot of health is not within our control. Systemic forms of oppression— fat phobia and weight stigma, racism, sexism, xenophobia, transphobia, homophobia, ableism, classism, ageism — as well as other social determinants of health, such as trauma, employment, education, access to health care, housing, work environment, water and sanitation, and so on, can and do impact health, and any nutrition or movement intervention must be considered against the context of the individual’s lived experience.
3. “Healthy eating” looks different for everyone, and is ultimately up to the individual (with support, potentially) to decide for themselves. While someone may benefit from a vegetarian diet filled with culturally appropriate foods, another person may feel better eating more animal foods. Teaching our clients to become their own “nutrition experts” may come about through the process of intuitive eating (a dynamic interplay of instinct, emotion, and thought) or various other branches, such as connected or attuned eating. A weight-inclusive practitioner generally understands and accepts a wide spectrum of eating patterns. While we may offer information (with consent) on macronutrients and micronutrients, fibre, blood sugar balance, supplementation, and so on, we tend to leave food choices up to the client. We acknowledge that an individuals’ eating behaviours are composed of many facets, including access and ability. Some cultural foods do not align with Eurocentric definitions of “healthy eating,” but that doesn’t mean they are not health promoting or necessary for the individual in the room.
4. We reject the Eurocentric notion that there are “good” and “bad” bodies. We believe all bodies have value, including underrepresented bodies. We acknowledge that the changing ideal — currently a thin, shredded body, often tanned, with a developed backside and visible abdominal muscles — is influenced by a number of factors and is rooted in oppressive twentieth century ableist, classist, sexist, racist, and ageist beliefs. We recognize that “fit” is a state of being, not a look, and that many people will never meet social criteria for “a good body” due to their genetics, ability, and so on. The elevation of a certain body type over others as a symbol of moral virtue or superiority is used to oppress others, particularly marginalized people. We recognize that striving to achieve a certain aesthetic, whether thin and/or muscular, can often lead to poor health outcomes, particularly in those who are not genetically destined for thinness. For example, to escape the weight of stigma, larger-bodied folks may engage in disordered eating or compensatory behaviours, and may run the risk of developing a clinical eating disorder.
5. We refer often to the social determinants of health, and view health as incredibly complex. As discussed, while nutrition and movement (if desired and able) are important, they must always be considered within the context of the individual’s lived experience in their body. In addition to talking about food and exercise, weight-inclusive providers often discuss the role of self-compassion, mindfulness (not necessarily mindful eating, which is often co-opted for weight loss purposes), self-care, body image, and the emotions, and may consider how past behaviours that were used to adjust to situations are currently showing up on the plate and interfering with an individual’s overall quality of life.
What questions do you have about what it’s like to work with a weight-inclusive practitioner?