When you begin to challenge the dominant weight paradigm, you will get a lot of questions from others who are either trying to understand a body liberation and Health At Every Size® (HAES) approach, or are resistant and stuck in old ways of seeing the issue. In response to these questions, you might find yourself in a freeze response, and struggle to have the answers to their questions.

With this scenario in mind, I invited two of my favorite Nutritionists to answer the common questions a person may encounter when sharing this weight-inclusive paradigm. Anna Lutz of Lutz, Alexander & Associates Nutrition Therapy and Annie Goldsmith of Second Breakfast Nutrition are HAES® aligned Dietitians and colleagues in the Embodied Recovery for Eating Disorders approach. They are both offer a wealth of concise information (and are delightful humans!), and share their answers to your questions below.

It is our intention to empower you with information as you integrate this weight inclusive paradigm into your life.

Question: There may be lots of heavier people that are healthy, but what about the extreme where someone is 600#. It’s dense to say that they wouldn’t improve their health and mobility if they lost weight.

What we know for sure is that intentional weight loss attempts are often harmful and largely unsuccessful. 95-98% of people who diet gain back all the weight within 5 years, and ⅓-⅔ of people will gain more than they lost. Much of this argument is a moot point because we literally don’t know how to make a fat person thin in the long term.

Dieting is also not a neutral intervention in terms of quality of life or risk. Dieting is often a gateway to the development of an eating disorder. Dieting negatively impacts mood, relationships, energy, concentration, sex drive, and cognition.

Believing one’s body is wrong for being fat undermines self esteem, body image, sense of self worth and ability for self compassion. A weight-inclusive intervention can focus on behavior change that we know unequivocally supports health - joyful movement, body-attuned eating, stress management, and social connection. These are things that can be worked on without the negative side effects of dieting.

Question: There has to be a limit, right? At some point XX lbs is more than is healthy.

One of the Health at Every Size Principles is Weight Inclusivity: Accept and respect the inherent diversity of body shapes and sizes and reject idealizing or pathologizing specific weights. By saying there’s some limit to that, going against this principle.

HAES takes the focus off of weight and on to policies and approaches to healthcare that supports individuals’ true health. Saying someone will improve their health if they lose weight, is not evidence based and causes harm. If an individual has goals to improve their health, focusing on health promoting behaviors, eating for well being and life enhancing movement, two other HAES Principles, may improve health, regardless if one’s weight changes. Furthermore, reducing weight stigma in our healthcare system and culture will greatly improve the health of those with larger bodies.

Question: If we can say that someone’s BMI/weight is too low, then why is no weight too high? If someone can eat little enough/starve to get to a low weight, why are we pretending that someone couldn’t also overeat to a high weight?

Set point theory tells us that weight is a largely heritable trait that is driven about 70% by genetics. Under normal conditions (i.e adequate and appropriate nutrition, sleep, stress management and movement) weight will settle and stabilize in this range, which could be from a very low to a very high body weight. When we are talking about weight that is “too low” or “too high” this needs to be understood in the context of an individual’s set point range.

The next thing to understand is that from an evolutionary perspective, being “underweight” is much more threatening to survival than “overweight”, as historically underweight was a result of lack of access to adequate nutrition. Scarcity of resources is life threatening, abundance is not. Bodies have evolved to resist weight loss and drive set point up, especially under conditions of scarcity, in the service of survival.

HAES acknowledges that certain factors may drive set point weight up - chronic dieting is one of these factors. HAES also places the focus on health promoting behaviors. In healing from any form of an eating disorder, the nutrition goal is for a person to give the body adequate nutrition. A body cannot be fully nourished below its setpoint weight.

Question: But it’s not healthy to be fat, obesity is unhealthy. Diabetes, etc. How can you ignore that?

Looking at the health and weight research, there is a correlation between higher weights and certain health conditions, such as diabetes and hypertension. However, we know that correlation does not equal causation. When you look at the research further, we see that weight cycling and weight stigma are 2 possible reasons that we may see this association.

When one controls for weight cycling in the very large NHANES and Framingham studies, the correlation between weight and these health conditions goes away. Higher weight people are much more likely to diet and weight cycle - which could be the source of health conditions correlated with high weights.

The weight sigma research is clear, that experiencing weight stigma increases an individuals’ risk of certain health conditions. And, like we said earlier, there is no evidence in the literature that it is possible for the majority of people to lose weight and keep it off. So, prescribing weight loss as a treatment for disease is an exercise in futility (and it causes harm!!).

Question: But that’s just for those recovering from an eating disorder. I am talking about health – diabetes, cholesterol, etc.

It is overly simplistic to attach a singular diagnosis to a person as if one label can characterize the overall complexity of someone’s health. Many people with diagnosed eating disorders also have other medical diagnoses such as diabetes, etc. Many people with medical health conditions also have eating disorders or disordered eating. People who hold marginalized identities - such as being fat, BIPOC, LGBTQ and/or disabled - are much less likely to have their ED diagnosed and treated than their thin, white, cis, able bodied counterparts.

Additionally, the discrimination these populations experience may be part of what causes them to also be at higher risk for these medical conditions. There is much intersection in the prevalence of ED and medical diagnoses, and when we consider body-based stigma may be at the root of the development of both, we become obligated to consider them together in an interdependent way.

Question: If you aren’t measuring weight as an outcome, how do you track progress/success?

The work we do is highly individualized. As a HAES healthcare professional, I don’t assume my goals are my client’s goals. Together, we will outline what progress looks like for them, as it relates to their values and what is important to them.

Examples of progress for people may be, having more energy, eating regular meals and snacks, reducing eating behaviors they are concerned about, exercising more or less , thinking about food less, eating more of a variety of foods, and improving health markers such as blood sugar and blood pressure levels.

Question: But what about (insert an extreme example or sensationalized tv show?

Yes, what about it? In our opinions, shows like The Biggest Loser or My 600 Pound Life lead to weight stigma and harm in our society. (The podcast Maintenance Phase is an excellent resource for debunking fad diets and extreme examples.)

Question: But what about their knees?

People of all sizes have knee problems. Regardless of one’s size, if someone has new discomfort that they want to improve, approaching a physical therapist for an assessment and treatment is evidence based care. I encourage my clients to ask their provider, what would you recommend for a client in a smaller body? A patient could also ask any provider who is pushing weight loss as intervention to supply the data to support that the recommendation will be successful in the long term (spoiler alert: there is none!) There is great blog post by Dr. Louise Metz with more about the data about joint pain and weight:

https://mosaiccarenc.com/uncategorized/joints-weight-inclusive-care-osteoarthritis/

Question: So, this approach is like harm reduction?

No, in part because “harm reduction” implies that fatness is harmful in the first place. Fat is not harmful; fatphobia is what harms. Until we eradicate weight stigma and fat phobia from the experience of fat people in the world, there is no basis for the argument that fat causes harm. What this is is the unequivocal assertion that fat people, like all people, deserve to be treated with dignity, respect, and basic human decency. Fat people deserve the same rights and access to resources as their thinner counterparts. This is about acknowledging the basic humanity of all people no matter their size and leading from that place.

Are you ready to challenge the dominant paradigm and move towards body liberation?

Join us at Reclaiming Beauty as we start a journey toward freeing ourselves from diet culture. Our disordered eating therapists stand ready to support you in reclaiming your innate beauty and authenticity. Follow these few steps to get started:

Contact us so we can get to know you better.
Learn more about our approach!
Discover more about Health At Every Size®.

Other Services We Offer in Asheville, NC

Discover a holistic approach to well-being at Reclaiming Beauty. Our personalized embodiment coaching unlocks the wisdom within, fostering self-compassion and resilience. Or, explore the transformative benefits of the Safe and Sound Protocol (SSP). This is a non-invasive auditory intervention that enhances social engagement and reduces stress. We also offer body-centered psychotherapy!

Make an appointment

Much gratitude to our guest Nutritionists

Anna Lutz, MPH, RD, CEDRD-S

Anna Lutz is a Registered Dietitian with Lutz, Alexander & Associates Nutrition Therapy in Raleigh, NC and specializes in eating disorders and pediatric/family nutrition. Anna received her Bachelor of Science degree in Psychology from Duke University and Master of Public Health in Nutrition from The University of North Carolina at Chapel Hill. She is a Certified Eating Disorders Registered Dietitian (CEDRD) and an Approved Supervisor, both through the International Association of Eating Disorder Professionals (iaedp). Anna previously worked at Children’s National Medical Center in Washington, DC and Duke University Student Health, treating individuals with eating disorders. She has completed extensive training through the Embodied Recovery Institute and strives to provide her clients trauma and somatically informed care. Anna is a national speaker and delivers workshops and presentations on eating disorders, weight-inclusive healthcare, and childhood feeding. She also writes and talks about nutrition and family feeding, free of diet culture, on her blog, Sunny Side Up Nutrition, and her podcast, Sunny Side Up Nutrition Podcast.

Annie Goldsmith, RD, LDN

Annie Goldsmith, RD, LDN holds an undergraduate degree from the University of Rochester in Brain and Cognitive Sciences and attended Winthrop University for her graduate coursework in human nutrition. Her educational and professional trajectory has always been guided by a strong curiosity about the ways our biology and psychology interact to inform our human experience. Annie worked in neuroscience research labs at New York University and Davidson College before pursuing a career in nutrition. She has experience treating eating disorders at the PHP, IOP, and outpatient levels of care. She opened her outpatient group practice, Second Breakfast Nutrition, in 2015.

Annie’s practice is rooted in a foundational belief in the inherent worthiness of all bodies. She centers weight inclusive, social justice oriented, and trauma informed frameworks in her approach to eating disorder care and recovery. Annie became interested in somatically oriented and trauma-informed approaches to nutrition therapy in 2018, when she began training with the Embodied Recovery Institute. She is passionate about working with clients from the “bottom up”, centering and supporting the wisdom of the body and it’s innate capacity for healing.

Are You Ready to Challenge the Dominant Paradigm?

Join us at Reclaiming Beauty as we start a journey toward freeing ourselves from diet culture. Our disordered eating therapists stand ready to support you in reclaiming your innate beauty and authenticity. Follow these few steps to get started:

Contact us so we can get to know you better.
Learn more about our approach!
Discover more about Health At Every Size®.

Other Services We Offer in Asheville, NC

Discover a holistic approach to well-being at Reclaiming Beauty. Our personalized embodiment coaching unlocks the wisdom within, fostering self-compassion and resilience. Or, explore the transformative benefits of the Safe and Sound Protocol (SSP). This is a non-invasive auditory intervention that enhances social engagement and reduces stress. We also offer body-centered psychotherapy!