Weight Neutral

Weight Inclusive

Health At Every Size®

Non-dieting

Intuitive Eating

Conventional Obesity Interventions

• Weight loss interventions & restrictive dieting can lead to negative effects:• binge eating and eating disorders

• body dissatisfaction

• low self-esteem

• culpability and stigmatization of the fat body

• Weight loss interventions typically have a low success rate

Weight-Centric Healthcare Model

False Negatives False Positives

Tylka et al., J Obes. 2014; 2014: 983495

e.g. Healthy person with BMI > 25 may be prescribed weight loss

e.g. “Normal” weight person may have undetected insulin resistance/prediabetes due to not being screened

HAES challenges assumption that:

1. adiposity poses significant morbidity and mortality risk,

2. weight loss will prolong life,

3. anyone who is determined can lose weight and keep it off through appropriate diet and exercise,

4. the pursuit of weight loss is a practical and positive goal,

5. the only way for people living with obesity to improve health is to lose weight, and

6. obesity-related costs place a large burden on the economic and health system, and this can be corrected by focused attention to obesity treatment and prevention.

Penney & Kirk, Am J Public Health. 2015 May; 105(5): e38–e42

HAES1) encourage body acceptance

2) support intuitive eating

3) support active embodiment(“intuitive exercising”)

Bacon & Aphramor, Nutr J. 2011 Jan 24;10:9

Intuitive Eating

Unconditional permission to eat

Reliance on hunger and satiety cues

Eating for physical rather than

emotional reasons

Body-food choice congruence

Increased:

• Body satisfaction

• Body image acceptance

• Self-compassion

• Feelings of satisfaction with life

• Self-esteem

• Focus on exercising for enjoyment and/or health-related reasons

• Diet quality and/or eating behaviours

• BMI, blood pressure, triglycerides, etc.

• Preoccupation with food

• Feelings of shame about appearance

• Binge eating episodes

• Anxiety & depression

• Perfectionist tendencies

Decreased:

Van Dyke & Drinkwater, Public Health Nutr. 2014 Aug;17(8):1757-66

0 105

Ref: Jake Linardon, breakbingeeating.com

Absolutely Empty

Full Stuffed FullOverfull

82

Getting Empty

Ideal Before Meal Score

Ideal Towards End of Meal Score

Hunger-Fullness Scale

Intuitive Exercising: Enjoyable Activity

Promote healthy behaviors regardless of body size & shape

All foods allowed without judgement

Weight-loss goals incompatible with HAES

Brevers et al., Front Psychiatry. 2017; 8: 243

Agreement• Weight or BMI alone are not reflective of health status

• Lower body weight doesn’t always mean better health (e.g body comp)

• Dieting-regain cycles are psychologically damaging

• Weight re-gain occurs due to metabolic adaptations & compensatory physiology (homeostasis)

• Weight bias & discrimination is a real problem

• Focusing on behaviours > focusing on weight outcome

• Health can be improved in lieu of weight loss*

• Seeing it as an individual responsibility issue ignores big issues like socioeconomic status (Side Note: HIER [1])

[1] Bombak, Am J Public Health. 2014 February; 104(2): e60–e67

Potential Criticisms

• Idea of “problematizing obesity”

• Diets are doomed to fail - “95% of diets won’t work”

• Latency/lag time of chronic disease development

• Weight loss is the primary driver of T2D risk reduction in people who are overweight [2]

• Improvements in psychological well-being with weight loss/ body composition alteration

• “… is it an appropriate population health approach if one considers our current obesogenic environment?” – Penney & Kirk, 2015 [1]

[1] Penney & Kirk, Am J Public Health. 2015 May; 105(5): e38–e42

[2] Guess, Nutrients. 2018 Sep; 10(9): 1245

Weight GainWeight Loss

• Genetics• Psychological Distress• Socioeconomic Status• Behaviours

Weight GainWeight Loss

Obesogenic Environment

Obesogenic Environment Slope Idea: Credit to Swinburn & Egger, BMJ. 2004 Sep 25;329(7468):736-9

Wing et al., Diabetes Care. 2011 Jul; 34(7): 1481–1486

Cha

ng

e in

Hb

A1c

(%)

-0.6

-1

- 0.2

Wing et al., Diabetes Care. 2011 Jul; 34(7): 1481–1486

Cha

ng

e in

Fa

stin

g G

luco

se (

mg

/dl)

-30

-50

- 10

Wing et al., Diabetes Care. 2011 Jul; 34(7): 1481–1486

Cha

ng

e in

Blo

od P

ress

ure

(m

mH

g)

-8

-14

- 2

Systolic

Diastolic

Wing et al., Diabetes Care. 2011 Jul; 34(7): 1481–1486

Cha

ng

e in

Tri

gly

ceri

des

(m

g/d

l)

-50

-100

0

Heuristics for Health Enhancement

• Diet pattern

• Basic food preparation skills

• Food decisions that benefit psychological well-being

• Light & dark exposure

• Sufficient time allocated for sleep

• Activity built into lifestyle

• Structured exercise

• Social interaction & relationships