This article by Maeve Hanan (Registered Dietitian & Founder of Dietetically Speaking) will explain what weight-inclusive care means and why we are passionate about working in this way at Dietetically Speaking.

Weight-Inclusive 101

Weight-inclusive care acknowledges that health and well-being are impacted by many factors while also emphasising the importance of making health care more inclusive and reducing weight stigma (1). 

The big difference here is that health is not defined by weight.

This doesn’t mean that weight has no impact on health or wellbeing, but it zooms out to take in the bigger, more nuanced picture of health and acknowledges the issues outlined in this article related to pursuing weight loss which impact many people. 

Sometimes ‘weight-neutral care’ is used interchangeably with ‘weight-inclusive care’, as there is significant overlap in that weight neutrality focuses on health gain rather than weight loss. However, weight-inclusivity appreciates that people living in different sized bodies may have different health needs that should be properly addressed in order to provide the best care possible. For example, having a higher fat mass may impact equipment requirements or supplement dosing (etc.). 

Weight inclusive care involves the following principles (1):  

• Do no harm.
• Appreciate that bodies naturally come in a variety of shapes and sizes, and optimal care should be provided to everyone, regardless of their size.
• Maintain a holistic health care approach rather than undue focus on weight or size.  
• Encourage process-focus goals instead of ‘final destination’ goals for improved day-to-day quality of life. 
• Critically evaluate the strength of evidence for weight loss treatments, including research gaps and limitations.  
• Provide sustainable, evidence-based advice on health behaviours e.g. joyful movement, nourishing diet, good sleep, stress management etc. 
• Try to improve access to person-centred, non-stigmatising health care and social justice for everyone on the weight spectrum. 

There are a number of different approaches that are considered to be weight inclusive, such as:

• Health at Every Size (HAES®)
• Non-diet or anti-diet approaches
• Intuitive Eating
• Mindful eating
• Nutrition counselling

Does Weight Inclusive Care Mean That Discussing Weight is Off-Limits?

Weight-inclusive care doesn’t mean that you can never discuss or check your weight. This is an individual decision, as nothing is black or white. The desire to lose weight is also very understandable based on the society we live in and all of the fatphobic messages we are surrounded by.  

Of course, everyone is individual, so for some people focusing on losing weight may work and be sustainable. But based on our experience, and the current evidence base, this seems to be the minority.   

Again, you are the expert of your own body so in an ideal world, you get to decide whether you want to work with a weight-inclusive or weight-centric Dietitian. Unfortunately in reality it can be more difficult or more expensive to access weight-inclusive care, particularly as this is currently less common within public healthcare settings. 

What’s the Evidence for Weight-Inclusive Care?

Weight-inclusive approaches have been linked with significant improvements in (2-5): 

• Health behaviours e.g. increased movement and nutritious food choices
• Blood pressure
• Cholesterol levels
• Self-esteem and mood
• Body image
• Weight stability
• Eating behaviours i.e. a reduction in disordered eating
• Engagement levels i.e. lower dropout rates  

Intuitive eating has also been associated with improvements in blood glucose control in those with diabetes (6-8). 

This is in contrast with research that has found that focusing on weight loss can be unsustainable, stigmatising and can contribute to worsened mental health, body image and relationship with food. For more information about the issues with the weight-centric approach, check out this article. 

Ongoing high-quality studies are needed to investigate the impact of weight-inclusive approaches in a variety of groups, as this is still a relatively new area of research.  

Why We Work in a Weight-Inclusive Way

At its core, weight-inclusive care is compassionate, respectful, inclusive, person-centred and holistic.

This is how we believe people should be treated when they seek support from healthcare professionals. 

A vital part of providing safe healthcare is doing no harm, and evidence is mounting about the risks related to the pursuit of weight loss. 

In our clinical experience we have also seen the life-changing benefits that this type of care can have; particularly for those who have had a difficult relationship with food and their body (which is a very high percentage of people, unfortunately).  

All in all, we are passionate about this approach approach from both an ethical and an evidence-based standpoint, and we hope that weight-inclusive care continues to become more readily available across the board.  

References:

1. Tylka, T.L., Annunziato, R.A., Burgard, D., Daníelsdóttir, S., Shuman, E., Davis, C. and Calogero, R.M., 2014. The weight-inclusive versus weight-normative approach to health: Evaluating the evidence for prioritizing well-being over weight loss. Journal of obesity, 2014. [accessed November 2021 via: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4132299/] 
2. Bacon, L. and Aphramor, L., 2011. Weight science: evaluating the evidence for a paradigm shift. Nutrition journal, 10(1), pp.1-13. [accessed November 2021 via: https://pubmed.ncbi.nlm.nih.gov/21261939/]   
3. Tylka, T.L., Calogero, R.M. and Daníelsdóttir, S., 2020. Intuitive eating is connected to self-reported weight stability in community women and men. Eating disorders, 28(3), pp.256-264. [accessed November 2021 via: https://pubmed.ncbi.nlm.nih.gov/30821648/]  
4. Clifford, D., Ozier, A., Bundros, J., Moore, J., Kreiser, A. and Morris, M.N., 2015. Impact of non-diet approaches on attitudes, behaviors, and health outcomes: A systematic review. Journal of nutrition education and behavior, 47(2), pp.143-155. [accessed November 2021 via: https://pubmed.ncbi.nlm.nih.gov/25754299/]  
5. Carbonneau, E., Bégin, C., Lemieux, S., Mongeau, L., Paquette, M.C., Turcotte, M., Labonté, M.È. and Provencher, V., 2017. A Health at Every Size intervention improves intuitive eating and diet quality in Canadian women. Clinical nutrition, 36(3), pp.747-754. [accessed November 2021 via: https://pubmed.ncbi.nlm.nih.gov/27378611/] 
6. Soares, F.L.P., Ramos, M.H., Gramelisch, M., Silva, R.D.P.P., da Silva Batista, J., Cattafesta, M. and Salaroli, L.B., 2021. Intuitive eating is associated with glycemic control in type 2 diabetes. Eating and Weight Disorders-Studies on Anorexia, Bulimia and Obesity, 26(2), pp.599-608. [accessed November 2021 via: https://pubmed.ncbi.nlm.nih.gov/32232778/]  
7. Quansah, D.Y., Gross, J., Gilbert, L., Helbling, C., Horsch, A. and Puder, J.J., 2019. Intuitive eating is associated with weight and glucose control during pregnancy and in the early postpartum period in women with gestational diabetes mellitus (GDM): A clinical cohort study. Eating behaviors, 34, p.101304. [accessed November 2021 via: https://pubmed.ncbi.nlm.nih.gov/31154153/]  
8. Wheeler, B.J., Lawrence, J., Chae, M., Paterson, H., Gray, A.R., Healey, D., Reith, D.M. and Taylor, B.J., 2016. Intuitive eating is associated with glycaemic control in adolescents with type I diabetes mellitus. Appetite, 96, pp.160-165. [accessed November 2021 via: https://www.sciencedirect.com/science/article/abs/pii/S0195666315300271]