Why I Won't Sell Weight Loss: One Dietitian's Journey from Weight Loss to Weight Neutral
I’m a Registered Dietitian. If you’re here, you probably know that already. But what you might not know is that I refuse to sell you weight loss. Most people are surprised by that, and I’ll be honest -- sometimes it surprises me, too. I didn’t get into nutrition to become a Health At Every Size practitioner. In fact, I didn’t know what that was until fairly recently. When I made the choice to get my RD, I thought weight loss was the goal. What I’ve learned since the day I walked into my very first nutrition lecture probably couldn’t have been taught in a classroom alone. As Registered Dietitians, our jobs are to practice nutrition based on the evidence. This is what sets us apart from the pseudo-science-based pop “experts” who follow trends, and market what is popular or profitable. At this time, the evidence shows me that the most ethical thing I can do as a nutrition practitioner is to encourage my clients to remove a weight goal from their list. Research has now conclusively shown us that dieting does not work, and paints this bleak picture of our current outlook:
“Despite attention from the public health establishment, a private weight loss industry estimated at $58.6 billion annually in the United States , unprecedented levels of body dissatisfaction  and repeated attempts to lose weight [3, 4], the majority of individuals are unable to maintain weight loss over the long term and do not achieve the putative benefits of improved morbidity and mortality .”
- Excerpt from Nutrition Journal Article, Weight Science: Evaluating the Evidence for a Paradigm Shift (1) *Reference numbers refer to original article citations
In research conducted over the last two decades, we have seen that, while some diets lead to short term results, diets repeatedly do not produce long term, lasting weight loss, and participants even often regain weight beyond their starting point. In fact, many studies reveal dieting itself to actually be a predictor of weight gain, not to mention a risk factor for developing disordered eating and body dissatisfaction (2). As Linda Bacon, PhD, author of Health At Every Size, often points out, the research does not show us that weight itself is the issue, or even a risk factor on its own. In looking at a disease like hypertension, researchers see more deaths in thinner people than heavier people (3). In patients with diabetes, hypertension, and other diseases we tend to associate with obesity, it is possible that it is not weight gain that is the cause, but rather the weight cycling that results from chronic dieting (4). Adults 55 years of age and older were found to typically live longer with higher BMIs than their more slender counterparts (5). Not only that, but this same study also saw much stronger correlation between factors like low socioeconomic status and mortality than it did with weight (5). Recommending weight loss as a cure-all for metabolic disorders not only doesn’t fit with what research currently supports, but also blinds us to the bigger issues we face in our society’s relationship to our food and bodies. An analogy I once heard suggests that recommending weight loss to solve metabolic diseases is like seeing a smoker with emphysema, and recommending they begin whitening their teeth. Higher weights might be a side effect of a sedentary lifestyle, and having lost touch with our bodies’ hunger and fullness cues, but attacking the weight itself is not the answer. These studies support that it is not ethical to suggest weight loss -- in fact, it is downright dangerous. As a dietitian who prides herself on practicing according to what the evidence shows me, I cannot in good conscience sell weight loss. As mentioned, I didn’t start out this way. While studying nutrition, we are taught that weight itself is a risk factor for mortality and morbidity. We are taught to focus on calories in and calories out. When training on how to make positive changes in people's diets, we look at how we can shave off calories and fat, and increase activity through monotonous movement. I’ll be the first to admit it - I practiced this way. Whether working with people professionally, or answering questions for friends and family, my answers went back to my education. But it’s been through my hands-on experience and witnessing the long term impact of this advice that I’ve come to find that weight is not the problem, and therefore not the solution.
The truth is, the cycle dieting creates has far more morbid and, frankly, uncomfortable effects on our bodies than resting at a BMI outside of what is arbitrarily listed as “healthy” (6). Restrictive eating, whether it is as blatant and extreme as pure calorie restriction, or masked as something like fitting your “macros”, or ruling out a certain food group for a “healthy lifestyle”, will always lead to a famine response. What this means is that, due to your body’s basic physiological response to being starved, it is highly unlikely that you will be able to go near anything your body perceives as energy without eating more than you intended. This is not your fault, or lack of willpower or self control. This is survival. This is your body making sure you have enough energy for your heart to beat, for your lungs to breathe, and for your brain to stay awake, even when fuel is scarce. We can see this happen, physically, right in front of us. And it is not your fault, and you are not “bad” or “weak”. This is you, being a living creature who requires fuel. As I always share with my clients who come to me wondering why they feel unable to stick to any diet they try, I would like to emphasize this: You have not failed at these diets. These diets have failed you. I would like to argue that our nation’s struggle with weight and food has so much more to do with getting out of touch with our bodies’ cues due to dieting, than it does with any one particular ingredient, cooking method, restaurant chain, food group, or even weight itself. Our bodies want us to be healthy. Keeping us alive is their primary objective, and they call on complex mechanisms on a second-to-second basis to keep us in equilibrium. Why would our hunger and fullness cues be any different? Do I think that some people are at a weight outside of what their body is most comfortable at? Sure. But do I think we are going to remedy this through dieting and fixating on weight as our data point? Absolutely not. I think Dr. Bacon said it best in her response to one skeptic :
“Health at Every Size is not anti-weight loss. We understand that weight loss is a side effect that sometimes occurs when people adopt healthy habits – and we also recognize that many people who adopt healthy habits don’t lose weight. Our goal is to be weight neutral – to encourage the habits and attitudes which we know are valuable, and to let the weight settle where it may. And to support people in appreciating themselves no matter what the outcome. They don’t have to wait until they lose weight to feel good about themselves.”
So, I do not, and will not, sell weight loss. I sell permanent, lasting change. I sell a positive relationship with food, and never having to call yourself “bad” for listening to what your body is telling you. What I have on offer is the opportunity to stop battling your body, and learning, through hard work and dedication to your well being and emotional security, that you can trust the signals you hear, and trust your body to do what it needs to do. I sell peace and partnership with your mind and body. I urge you to take the first step toward listening to your body today. This might look like having one meal at the kitchen table today without distractions so you can enjoy your food. It might mean putting down a “healthy” food that doesn’t sound good, and picking up what your body is really asking you for. It might mean giving yourself a scoop of real ice cream instead of the dairy-free, fat-free, sugar-free, fuel-free version; or it may mean going for a walk outside, even though it burns fewer calories than that class at the gym, because it feels good to be outdoors. I can’t promise your journey will be easy. It may not be pretty. And it most definitely will not be linear. But I can promise you it is worth it. If this is something you’re willing to work for, and are looking for help, you know where to find me. Yours In Everlasting, Messy, Imperfect Wellness, Sam the Dietitian Works Cited:
Bacon, Linda, and Lucy Aphramor. "Weight Science: Evaluating the Evidence for a Paradigm Shift." Nutrition Journal. BioMed Central, 24 Jan. 2011. Web. 28 Nov. 2016.
Robison, Jon. “Health at Every Size: Toward a New Paradigm of Weight and Health.” Medscape General Medicine 7.3 (2005): 13. Print.
Barrett-Connor, E., and K. T. Khaw. "Is Hypertension More Benign When Associated with Obesity?" Is Hypertension More Benign When Associated with Obesity? | Circulation. American Heart Association, 1 July 1985. Web. 09 Dec. 2016.
Montani, J. P., A. K. Viecelli, A. Prevot, and A. G. Dulloo. "Weight Cycling during Growth and beyond as a Risk Factor for Later Cardiovascular Diseases: The 'repeated Overshoot' Theory." Nature.com. Macmillan Publishers, 2006. Web. 09 Dec. 2016.
Lantz, Paul M., Ezra Golberstein, James S. House, and Jeffrey Morenoff. "Socioeconomic and Behavioral Risk Factors for Mortality in a National 19-year Prospective Study of U.S. Adults." Socioeconomic and Behavioral Risk Factors for Mortality in a National 19-year Prospective Study of U.S. Adults. Elsevier, May 2010. Web. 09 Dec. 2016.
Devlin, Keith. "Top 10 Reasons Why The BMI Is Bogus." NPR. NPR, 4 July 2009. Web. 12 Dec. 2016.