Read that again.
This reminder is particularly important in January when we are inundated with marketing about shrinking our bodies. We have been fed a false narrative by society for far too long that implies people in smaller bodies are healthier than people in larger bodies. It’s not true. This false narrative is so ingrained in us that I have heard horror stories of people with cancer being complimented on their weight loss. So we judge people on their body size and - maybe even worse - we judge ourselves. Harshly.
"Diet" has become a dirty four-letter word because it’s been transformed from its original meaning "food and drink regularly consumed" into meaning "a regimen of eating and drinking sparingly so as to reduce one's weight." Here is the big problem - diets for weight loss don’t work. Don’t take my word for it, check out this interview of Dr. Traci Mann from the University of Minnesota who has studied eating habits, self-control and dieting for more than 20 years. Long-term, sustainable weight loss via diets happens for less and 5% of people. The people it does work for must spend the rest of their lives fighting their biology, constantly working to stay in the smaller body. It’s also not healthy to constantly fluctuate in weight which is what happens when we diet to lose weight.
To be fair, I recommend changing patients' diets almost daily. The big difference is my aim is to increase the nutritional quality of food to improve overall health and wellbeing. I work with people who are ill and want to use lifestyle changes to improve their health. I educate patients about fruits and vegetables, fiber, how to start their day with protein, etc. We don’t talk about calories or food restriction.
It breaks my heart when I work with patients with serious health concerns that are more focused on their body size and appearance than their health concerns. This desire to shrink our bodies doesn't come from a place of self love. It’s the false narrative that has been fed to us since childhood, that bodies should look a certain way and we should spend our life striving to achieve that look.
Unfortunately, in conventional medicine and in our collective consciousness weight and BMI have become determinants of health ranked alongside blood pressure, blood sugar and inflammatory markers. The trouble is you can be in a larger body and have excellent blood pressure, labs and physical fitness. I’ve worked with these people. Folks in smaller bodies can have high blood pressure, high blood sugar and elevated inflammatory markers. I've worked with these people too.
What I see happening in medicine is bias that hurts both people in larger and smaller bodies. We assume that someone in a smaller body must be eating well and exercising properly - false. We assume that someone in a larger body must be eating poorly and not exercising enough - false. If we just look at body size and make assumptions we are missing a lot. The conventional "calories in, calories out" model fails to account for how hormones, chemical exposure, access to healthy food, discrimination, poverty, childhood trauma, genetics, medications, inflammation, sleep and more contribute to our health and body size. What if we looked at someone in a larger body and asked about their access to fresh food, their chemical exposure and their stress level? We must take a holistic look at health and avoid overly emphasizing the importance of body size.
Here’s the thing: acknowledging that you can have health at every body size doesn’t mean that you forgo exercise and eat to excess. What I love about this approach is that we focus on what actually matters for health. We help people let go of restricting and dieting in exchange for intuitive eating (read more about intuitive eating here from my collaborator, Jesse Haas, CNS, LN). Often we end up eating because we are sad, bored, excited, stressed, etc. Let’s focus on behavior change around food that helps us learn and respect our natural hunger cues.
Approach exercise as a celebration of what your body can do. Let's stop thinking of it as punishment for eating "off plan" or something we must do to keep our bodies small. Instead, let's exercise for the joy of it, to manage our stress levels and improve our mood. With this shift you may start to look forward to exercise and you are more likely to make it a habit.
Yes, there will be comments about how adipose (fat) tissue is inherently dangerous and produces insulin and inflammatory cytokines. This is true. Adipose tissue in excess isn’t ideal and likely raises inflammation which damages our bodies. Weighing more than our skeletal frame can handle does put excess pressure on our joints. But I argue that shaming, restricting and overly focusing on shrinking your body size is also damaging to our bodies. Self-criticism raises inflammatory cytokines too. So what if we encourage healthy eating habits and exercise from a place of love and self-compassion? It’s worth a try.
If you want to read more about the science behind Health at Every SizeTM (HAES) check out this fantastic article in National Geographic.
For resources and support with HAES check out the community here.