In my last post, I defined Am I Hungry? as a non-diet, weight-neutral, mindfulness-based program. Although they are related and work well in conjunction with each other, each of these three tenets has distinct meaning and value worth exploring. I’m choosing to focus on weight-neutral first because it happens to be Weight Stigma Awareness Week.
Weight-neutral interventions are based on the fundamental idea that a person’s health status or risk level cannot be assumed based solely on a number on a scale. The weight-neutral approach acknowledges that body weight is determined by a complex set of genetic, metabolic, physiological, cultural, social, and behavioral determinants, many of which individuals cannot change. Instead of focusing on a weight-oriented outcome, participants in weight-neutral programs are taught to take charge of the factors they can, such as thoughts and behaviors, which ultimately lead to improved well-being, regardless of weight.
Why not weight loss?
Weight loss programs are ineffective. The fact that weight loss programs do not create lasting changes in weight or health has been proven time and time again. A recent comprehensive review published in the Journal of Obesity, “The Weight-Inclusive versus Weight-Normative Approach to Health”, concluded that no weight loss initiatives to date have generated long term results for the majority of participants. Results from a 2013 RAND study sponsored by the U.S. Departments of Labor and Health and Human Services show that participation in a one year weight control program in the workplace would be associated with a body weight reduction of approximately one pound for an average adult at the end of the first year. By the fourth year, this would be reduced to one-quarter of one pound.
The focus on weight loss can be harmful. While no organization would intentionally implement a program or service that was harmful to their employees, we need to be aware that this is potentially what is happening with weight loss programming. The Journal of Obesity review cited above summarizes numerous studies on the three most documented negative effects of the weight loss focus: weight cycling, disordered eating, and weight stigma. The conclusions of that review and other research are:
Weight Cycling: The most common outcome of weight-loss programs is not sustained weight loss, but weight cycling (the repeated gain and loss of weight, often referred to as yo-yo dieting). Weight cycling has been definitively linked with adverse physical health, including loss of muscle tissue, hypertension, chronic inflammation, more weight gain over time, less physically active lifestyles, some forms of cancer and, most notably, higher mortality. Weight cycling is also associated with diminished psychological well-being, such as greater emotional distress and lower self-esteem.
Disordered Eating: The pursuit of weight loss can lead to disordered eating behavior. The review finds “there is growing evidence that individuals who try to achieve and maintain a weight-suppressed state are at risk for binge eating disorder and bulimia nervosa.” Another recent study on a mindfulness based intuitive eating intervention extends this concern beyond diagnosed eating disorders to “problematic eating behavior” such as chronic overeating and loss of control over eating, which are surprisingly prevalent in American women.
Weight Stigma: The focus on weight and weight loss results in weight stigma. The prizing of thinness, weight loss and “healthy” weight as determined by a BMI scale creates the opportunity for weight stigma, or negative attitudes and beliefs about people who do not fit a certain weight category. Weight stigma is associated with diminished health and well-being including: increased caloric consumption, diminished exercise, binge eating behaviors, low self-esteem, depression, and a decrease in self-rated health.
Why weight neutral?
While most of the research on weight neutral interventions using a Health at Every Size® approach has occurred in the last decade, early results are promising. When tested against standard weight-focused approaches, the weight neutral approach results in significant improvements in physiological measures (e.g., blood pressure), health practices (e.g., physical activity), and psychological measures (e.g., self-esteem and disordered eating) when compared to standard dieting programs. Also of noteworthy importance is the fact that this weight-neutral model demonstrated lower dropout rates with none of the adverse outcomes that were found in the dieting group.
Further, workplace decision makers may be compelled to offer weight-neutral interventions to help avoid other negative unintended consequences of weight-focused programs, including potential legal ramifications and the exclusion of employees who may not be classified as overweight but could benefit from engagement in the intervention.
I’m aware that the subject of weight is a hot topic in the workplace wellness industry and welcome your comments. What are your thoughts? Do you support the paradigm shift to a weight neutral approach?