Why I don’t do weight loss
Registered Dietitians get a bad rap for being the “food police”. People think that all we do is help people lose weight. Neither of these things are true! There are dietitians who offer weight loss support; people do tell me their not-so-great past experiences where they felt judged. Even worse, that their concerns were dismissed.
As a registered dietitian and healthcare provider, I aim to give clients an experience that is non judgmental and honors a client’s autonomy. I maintain the mentality to meet clients where they are at. We discuss their goals, health, and experience with curiosity, not judgement.
My actual job as a dietitian is to use evidenced-based treatment options. These are backed by credible scientific research, to help identify and improve nutrition-related issues. To be honest, half of my time in post secondary education was spent learning how to read and interpret research.
So, what are you supposed to do? When there is research to both support and discourage weight loss as a treatment?
Here is the thing about research – it takes a lot more than one paper to confirm an idea. Like whether weight loss is or isn’t helpful. We’ve got to compile all the credible research. Then weigh the pros and cons of all of them. This is challenging for a lot of reasons. The two biggest reasons are:
- this is extremely time consuming
- researchers (and the people who fund them) tend to be biased
When looking at the evidence it does seem to indicate that weight loss is beneficial – in the short-term. The problem is that weight loss research tends to neglect long-term results. These studies usually last between 6-52 weeks with almost no follow-up with participants. Then there is the flip side of the coin. Health at every size (HAES) research shows that weight loss is rarely maintained past 1-2 years. Maintenance of weight loss being almost nonexistent 5 years post initial weight loss.
Additionally, people who have a history of dieting and weight cycling (losing and gaining weight over and over) tend to have a higher body weight in the long run. This is compared to when they first started intentionally losing weight. Ultimately this leads to worse health outcomes compared to people who maintain a higher body weight long-term.
HAES research has also found that improving health through diet, exercise, and other factors without weight changes still provides the same health benefits as the weight loss; but in a way that is sustainable.
It seems obvious when looking at the data to go with a weight-neutral approach.
so why is weight loss still so highly promoted by healthcare providers and the media?
Unfortunately, weight bias, healthism, fatphobia, and sizeism are rampant in North American society and they tend to be highly profitable. Much more funding goes into weight loss research. This includes:
- new diets
- exercise programs
- surgical interventions
- and many other types of treatment
While in comparison HAES or weight-neutral research is growing more slowly. This is likely a result of the length of time covered (decades vs 1 year).
I opt to follow HAES and use a weight-neutral approach. The evidence points to this being the best course of action for my clients’ health and well-being in the long run. The intent to lose weight can harm your mental, social, emotional health; as well as your physical health. There is also the fact that our body size is largely beyond our individual control. Body size is strongly controlled by genetics; similar to height, and the Social Determinants of Health.
Setting goals for your health that have nothing to do with weight (weight-neutral) are less extreme because we aren’t striving for weight loss. We can still improve your blood sugar, blood pressure, and lipid levels without weight being a factor. There are other ways to help reduce the risk of chronic disease and treat GERD without considering weight loss. There’s no need to slash your current diet with a machete to improve your health. Instead we can add in foods and address eating behaviours to improve your specific health concerns.
Where does that leave us?
The approach I use is far more sustainable and achievable. Especially compared to trying to completely overhaul a client’s life to lose weight. We want to ensure we aren’t damaging your mental, emotional, or social health while aiming to improve your physical health. This includes discussing:
- your relationship with food and your body
- social support networks
This eliminates any other underlying issues affecting your eating. If there are, we will address the issues we can and look for additional support for the issues we can’t. We work together so you can reach your goals and know your efforts can benefit you for life.