Ask The Dietitian: Health at Every Size

December 8, 2017

You can be healthy and fit without being thin. Healthy Lifestyle Image

As part of a social movement called Health at Every Size (HAES), dietitians and doctors are moving away from assessing people’s health according to their weight. The HAES philosophy is based on the idea that people of all sizes deserve respect and good health, and that size does not determine health.

Research shows that there are a high percentage of people in the "overweight" or even "obese" category according to Body Mass Index (BMI) that are metabolically healthy. At the same time, there are a significant percentage of "normal" weight people who are unhealthy, with diseases like diabetes, hypertension or high cholesterol. In addition, people in the overweight category actually live the longest. Maybe BMI has gotten it wrong all these years?

Behaviors are far better indicators of health than weight. If people are eating a healthy diet and exercising regularly, then they are doing everything they can! They are healthy. They don't need to lose weight. You could also look at other factors like energy level, mood, digestive health, and lab values to assess health holistically.

Of course, health is not the only reason people worry about weight. But it should be.

The HAES philosophy urges body acceptance. Our body shape and size is largely out of our control. Studies with identical twins indicate that obesity is 80% determined by genes. Trying to attain the appearance ideal perpetuated by the media benefits no one except diet and weight loss companies and may even cause harm. In her book Health at Every Size, Linda Bacon explains: “The war on obesity has taken its toll. Extensive “collateral damage” has resulted: Food and body preoccupation, self-hatred, eating disorders, discrimination, poor health... Few of us are at peace with our bodies, whether because we’re fat or because we fear becoming fat.” 

Diets don't work. Even if they provide some weight loss in the short term, diets are usually too regimented and restrictive to be sustainable, so people quit. They end up going back to their old eating habits and gaining the weight back, plus some extra pounds, since their metabolism had adjusted to the lower calorie intake on the diet. It is suspected that the leading cause of weight gain in this country is dieting. So, ditch the diet mentality! (And you don't need to do a cleanse either—that is what your liver and kidneys are for).

Surprisingly, often when people stop worrying about weight and focus on their behaviors instead, their health improves -- regardless of weight loss. Maybe excess weight is a symptom of a problem (like an unhealthy diet and inactivity), instead of a problem all on its own. Or maybe the stress of worrying about one's weight actually causes people to hold on to excess fat, possibly through the work of hormones like cortisol. Likely, people restrict their eating so much in fear of weight gain that it leads them to binge or over-consume calories in the long run. When the fear of fat is removed, it’s like a weight (ha ha) is lifted off the shoulders.

It’s well established in the field of psychology that when someone's behaviors are guided by intrinsic motivation (coming from within) and positive reinforcement (i.e. improved health), rather than external forces (like a doctor telling them they need to lose weight) and negative reinforcement (i.e. fear of weight gain), they are more likely to succeed. When people choose a realistic, long-term eating and exercise plan that meets their unique personal and cultural preferences over an extreme diet, they are more likely to improve their health.

So what should I eat?

(Adapted from Linda Bacon and Michael Pollan)

Enjoy a variety of food. Mainly plants. Not too much. Most of the time.


Can you elaborate a little?

  • ENJOY: You will be more satisfied by choosing foods that you enjoy. Eat foods that help you feel good. Only you can determine what foods these are.

  • VARIETY: Eating a variety of food ensures you get the range of nutrients your body needs. Aim for foods with vibrant colors and strong aromas, as these often parallel nutrient density.

  • PLANTS: Plant foods (fruits, vegetables, legumes, whole grains, nuts, seeds) are densely packed with nutrients; they should be the focus of your eating plan. Think of meat and dairy as a side dish.

  • NOT TOO MUCH: Practice mindful eating. Listen to your body to know when and how much food to eat. Take smaller portions. Eat slowly, without distraction (put down your phone). Check in with yourself mid-meal, and stop eating when you are satisfied, before you are full. Distinguish between physical and emotional hunger. Emotional eating happens in response stress/sadness/loneliness/boredom, etc., not a physical need. Find enjoyable and relaxing self-care activities (i.e.meditating, dancing, drawing) you can do instead of emotional eating.

  • MOST OF THE TIME: Choose nutrient-dense foods over processed alternatives more often. Not all your choices need to be nutrient-dense, however. Think big picture—pay attention to your overall dietary pattern instead of individual foods. There are no good or bad foods. You are not good or bad based on what you eat. Remove the judgement and black and white thinking around food. Moderation of processed food, not avoidance, is key. "There's plenty of room for Twinkies in the context of an overall nutritious diet." – Linda Bacon, Health at Every Size 


What about exercise?

The body is meant to move. One of the best things we can do for our health is to get some form of physical activity every day. No need to kill yourself at the gym or by doing CrossFit. Exercise should be enjoyable and part of your daily life—not "work" or something you do to "burn off" that bagel you just ate. Structure your life so that activity is naturally built in: park your car in the farthest away spot, get off the bus a stop sooner, take the stairs instead of the elevator, schedule outdoor activities like hiking or frisbee with friends, or go for a walk up the hill in between classes.

 You are the expert of your body—only you know best how to take care of yourself. Trust that your body will tell you what it needs. You just need to listen.

 

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Looking for more personalized nutrition advice?

  • Make an appointment with a UHS dietitian at etang.berkeley.edu or by calling the appointment line at 642-2000. The 45 minute appointments are $15 with SHIP.

  • Drop in for a free 20-minute session at Tang, Wednesdays from 2:30-5pm. Check in at Social Services office (room 2280).

  • If you have a history or are currently struggling with disordered eating/eating disorders, schedule with our eating disorder specialist, Toby Morris, MS, RD.