Evaluating Health Promotions with Weight-Neutral Outcomes

Weight discrimination is a serious issue in Western society. The current cultural western norm favors thin individuals, and this concept can be observed in everyday media. Television shows, billboards, magazines, and social networking place an emphasis on what a “normal” body is, which is incredibly subjective. If you do have a “normal” body, then individuals are still not “in the clear”. Maintaining your weight and body image has become incredibly important in western society.

Models are generally unhealthy, with dangerously low weights that impact them on physiological, psychological and social levels. However, this reality is not enough for the media. People who are overweight in television shows are not often cast as lead roles, nor are they as well-liked in said shows. In the job industry, people who have the necessary qualifications might be passed up for a position they are qualified for simply because their weight is being used as a judgment of character.

Individuals who do not meet these standards are often discriminated against which can have severe psychological effects such as reduced self-esteem, eating disorders and general weight stigmatization (Bacon, 2011, p.3). The Merriam-Webster Dictionary states that general discrimination can be defined as “the practice of unfairly treating a person or group of people differently from other people or groups of people”. Weight discrimination is a public health issue because it emphasizes that larger individuals cannot be fit, and this only intensifies the psychological damage.

Currently, there is a shift however in the weight paradigm, a new modality is emphasizing healthy behaviors that do not necessarily result in weight loss. Health at Every Size (HAES) challenges that idea rather than promoting weight loss, they argue for a shift in focus to weight-neutral outcomes.

Today, there is much concern over individuals who are “overweight” or “obese” and there are many policy’s in place that is seeking to diminish this epidemic (Bacon, 2011, p.3). Current concern is that this weight-focused modality is ineffective not only at producing healthier bodies but it is also damaging in the sense that it creates preoccupation towards food and body perception and often results in repeated cycles of weight loss and gain (also commonly known as yoyo-ing). This modality distracts individuals from reaching their personal goals and often results in reduced self-esteem, eating disorders, and other health problems (Bacon, 2011, p.3). It also places the emphasis on the wrong concept, that weight loss is the desired end goal, which is not true. Modifying lifestyle behaviors and setting personal goals that can achieve happiness is what will be ultimately important in maintaining health and wellbeing.

Aside from HAES, many other civil rights organizations are advocating for weight acceptance. Association for Size Diversity and Health (ASDAH) correlates their views with HAES and believes that education, increased research as well as enhancing the individual is what will help change the misperceptions about weight assumptions. There is also the Council on Size & Weight Discrimination who advocates ending weight discrimination, especially regarding medical treatment, insurance policies, and jobs.

HAES believes that the best way to improve general health is to honor your body, and this organization believes that “individuals should adopt healthier habits for the sake of health and wellbeing, rather than weight control”. Many organizations in the eating disorders field have adopted this approach, and randomized controlled trials have shown positive results.

There have been several clinical trials that have compared HAES’s modality to conventional obesity treatment. The evidence from these trials supports the HAE’s approach to changing health behaviors and there were improvements on a physiological level (e.g. blood pressure, blood lipids), health behaviors (e.g. an increase in physical activity, reduced symptoms of eating disorder pathology) and increased psychosocial outcomes (e.g. mood, self-esteem, body image). These studies showed retention rates substantially higher than those receiving conventional obesity treatment (Bacon, 2011, p.3). This is particularly important to acknowledge considering that most weight loss programs are generally viewed as something positive.

There is often the misconception that individuals who are overweight or obese are ultimately unhealthy. This misconception is reiterated consistently throughout the media (who portray overweight individuals as unhealthy), or via insurance companies who may or may not choose to ensure individuals who are overweight, and if they are, their premium might be higher than that of someone thin. This is an inaccurate misconception; weight does not signify healthiness. While a person who is overweight might be unhealthy, conversely, a thin person might be unhealthy as well. There is a new perception that individuals can easily be “fit” and “fat” at the same time.

One misconception is that weight loss will prolong life. Studies that have been conducted with individuals who have type 2 diabetes have shown that their glycemic control vastly improves after behavior change before weight loss is even seen. There is also the challenge that weight loss is associated with improvement in long term glycemic control. Individuals that underwent a type 2 diabetes trial showed initial improvements with weight loss, but that their glycemic index reverted to previous levels, despite the fact they had maintained their new weight (Ciliska, Kelly, Petrov & Chalmers, 1995, p.10). There is also the perception that individuals who are overweight have high blood pressure, and this is a sign of poor health. However, new studies have shown that individuals who are overweight might have hypertension simply because their heart must pump blood through a bigger vessel. It is of my concern when a thin individual has hypertension than when an overweight individual does.

Current measures that evaluate the level of someone’s health would be the body mass index calculator (BMI). Except at statistical extremes, the BMI (or just the percentage of body fat) has only weakly been able to predict longevity (Flegal, Graubard & Williamson, 2005, p. 1861). The Analysis of the National Health and Nutrition Examination Survey found that the greatest longevity in the United States were those individuals who were in the overweight category (Flegal, Graubard & Williamson, 2005, p. 1861). While obesity might be associated with increased risk for many diseases, causation has not been well established. However, the BMI is still used in standard medical practice, despite its inaccurate basis on one’s health.

The dieting industry in the United States is a very profitable one, pulling in over sixty billion dollars annually (Rice, 2007, p. 165). Programs such as Atkins, Weight Watchers, various protein products, and gyms all advocate for a healthier lifestyle, and often provide convenient ways in achieving these goals. However, media hype should not try and convince individuals that the body they have is inadequate because not all bodies are made to look the same. There is also an increased risk in health decrement for individuals who go through weight cycling, and most of those individuals are generally obese (Bacon, 2011, p. 5). Weight cycling increases inflammation and is associated with other diseases such as hypertension, increased insulin resistance as well as poorer cardiovascular outcomes (Montani, Viecelli, Prevot, Dulloo, 2006, p. 58). Focusing solely on weight loss outcomes is beneficial for the companies pushing their products, however, it is not beneficial for the individual who is trying to change their health goals.

It is worthwhile to discuss the discrimination that children who are overweight receive as well. Obese children face multiple biases from different sources, including their parents, health care professionals, and educators (Brownell, Puhl, Rudd, & Schwartz, 2005, p.55). These children are subject to harsher victimization, and frankly, it is terrible because it creates the mindset in the child’s head that they “are not good enough”. Physiologically, it is unfair for a child or adolescent to be placed on a diet just because their growth is disproportionate to their age. Trying to manage one’s weight before they are an adult is, frankly, a silly concept. Their bodies are changing too much from hormones and growth spurts that it is unlikely that their true size will be revealed until they are young adults. However, trying to modify a child’s weight while they are young creates the mindset that they are not good enough to belong in society, and this is incredibly damaging to their self-esteem. They are already aware if they are overweight, children are very observant, and they do not need anyone else telling them that they don’t quite fit in. This is another reason to shift away from a weight-focused perspective.

Policies that promote weight loss as feasible and beneficial only provide the soil needed for the seedlings of discrimination to thrive. However, a shift from utilizing weight-focused programs to weight neutral-programs is likely to be a daunting task, despite the evidence of its efficacy. However, HAES has proposed that more research is likely to result in better interventions because it will ideally narrow down the best treatment approaches. They partnered with ASDAH and proposed some guidelines to assist professionals who are working with implementing HAES. These include having interventions that focus on health, not weight, and should be marketed as “health promotion” rather than “obesity prevention”. HAES also proposes that interventions should avoid weight-based stigmas. It is unfair to use the term “obesity” because it’s meaning indicates that it is a disease, which bears a negative connotation. Interventions should also be holistic, should promote self-esteem, body satisfaction, and respect for body size diversity. Changes in lifestyle should be approached compassionately and with an approach that encourages self-care rather than a style that is prescriptive to meet the “recommended guidelines”. It is also important that these interventions focus on only changing behaviors that are focusing and have evidence that they will improve health. HAES believes that weight is not a behavior and therefore is not an appropriate variable to try and change.

It is in my opinion that there is a need for integration for this new policy. There are too many individuals who base their self-worth only on their bodies, which is an inaccurate gauge and too many companies who openly discriminate against those whose bodies are different from the norm. I do believe there is an increased need for education on this topic because I feel that not many people are aware of the damage weight-focused programs can do on the human psyche and the human body. Education may further reduce some of the misconceptions younger people have about their bodies, and it can positively increase awareness that what the media portrays is not considered to be normal, or healthy. A person’s self-worth should not be measured by the numbers on a scale, and as I stated previously, some individuals exist who are overweight but are healthier than thin individuals. One of my professors is considered overweight by her BMI, and she was telling a story in class about her experience with her weight. Although she does not ask to know her weight when visiting the doctor, her new doctor informed her that she was overweight and needed to lose weight for health reasons. She then stated the following week after her visit she climbed Mount Kilimanjaro, a very difficult feat that you need to be “fit” to do.

In conclusion, there is a definite need to shift our common perceptions about weight. Weight does not indicate one’s level of health, nor does it give insight to one’s character. Invoking this weight-neutral model like the organization Health at Every Size has suggested will be beneficial in retaining and maintaining ideal health behaviors, and it is far less stigmatizing than a weight-focused approach.

Increasing education about supporting body size diversity and eliminating weight discrimination will likely dissolve many of the biases the general public currently harbors which may further reduce the negative connotations individuals manifest about themselves. This approach has supporting evidence that shows its efficacy on a biopsychosocial model, a model that many practitioners use today. It is beneficial for the body physiologically, for it reduces insulin resistance, regulates blood lipid levels and can help regulate cardiovascular issues. It helps the psychological state regarding how someone evaluates their self-worth, self-esteem, or how subjective they might be to developing eating disorders or other pathologies, and socially it affects how it may shift some of the cultural norms we currently abide by today. Ultimately this shift in weight focus will allow individuals of various weights to be included in society, free of feeling guilt or shame that their bodies do not correspond with how the media thinks it should.

References

Bacon, L. (2011). Weight science: Evaluating evidence for a paradigm shift. Nutrition Journal , 10(9). doi: 10.1186/1475-2891-10-9

Brownell, K., Puhl, R., Rudd, L., & Schwartz, M. (2005).Weight bias: Nature, consequences, and remedies. (1 ed.). New York, NY: Guillford Press.

Ciliska D, Kelly C, Petrov N, & Chalmers, J. (1995). A review of weight loss interventions for obese people with non-insulin dependent diabetes mellitus. Canadian Journal of Diabetes Care, 1995, 19: 10-15.

Flegal K., Graubard B., Williamson D., & Gail, M. (2005). Excess deaths associated with underweight, overweight, and obesity. JAMA, 293: 1861-1867.

Health at every size. (2014, April 10). Retrieved from http://www.haescommunity.org/resources.php

Montani JP, Viecelli AK, Prevot A, Dulloo AG: Weight cycling during growth and beyond as a risk factor for later cardiovascular diseases: The 'repeated overshoot' theory. International Journal of Obesity, 30 Suppl 4:S58-66.

Puhl, R., Andreyeva, T., & Brownell, K. (2008). Perceptions of weight discrimination: Prevalence and comparison to race and gender discrimination in America. International Journal of Obesity, 32, 992-1000.

Rice, C. (2007). Becoming "the fat girl": Acquisition of an unfit identity. Women's Studies International Forum, (30), 158-174. doi: 10.1016/j.wsif.2007.01.001