Intuitive Eating Blog Series - Part 1: Health at Every Size and ditching diet culture
So, last week over on Instagram I posted about "gentle nutrition," a term coined in the book Intuitive Eating by Evelyn Tribole and Elyse Resch (highly recommend that you stop reading this post, grab a copy here, and dive in!). Here's what I said:
“Let’s talk about “gentle nutrition.” This is the idea that nutrition IS important, but what’s more important is your overall quality of life. You should be able to eat tasty food because you want to, and ALSO choose foods that nourish your body. Once #weightloss is out of the picture, gentle nutrition is a way to take care of your body without sacrificing your mental health. 💖 You can enjoy fruits, veggies, whole grains, etc. without the deprivation/guilt cycle of a diet (this is one reason #whole30 and #paleo are still diets). ”
I got A LOT of great responses and tons of questions about this concept! But like the post says, before diving into gentle nutrition, you need to start with a total mindset change regarding healthful eating. For nutritious eating to come from a place of true self-care, it cannot in any way involve dieting or weight loss. I decided that before posting about gentle nutrition, I needed to create some solid content beyond my personal journey that explains my views on weight and health. So.... welcome to the Intuitive Eating Blog Series! Grab a cup of your favorite hot beverage and let's start off with the basics.
Health at Every Size
Recently,Kirstin Kadé, a nutrition graduate student in the UK, wrote a wonderfully informative article about Health at Every Size (HAES) for a women's health website called Glow Gathering. I recommend you read through it! She asked me to contribute a blurb on my thoughts for this article, which I was more than happy to do. I've reworked and expanded on those thoughts here.
Health at Every Size is a movement that looks beyond weight as a measure of health. It is radically against diet culture, seeking to promote healthy behaviors and quality medical care for every person in every body. HAES recognizes that the current healthcare system (especially in the US) is fatphobic and weight loss oriented, and that people in larger bodies face weight stigma every day.
But what is diet culture? And weight stigma?
Diet culture is the belief system that the key to health and happiness is thinness. It preaches that restriction is the ultimate form of righteousness, and that deprivation will somehow lead to joy. It praises disordered eating, fuels food fear, and breeds eating disorders. As Christy Harrison, MPH, RD says,diet culture is a life thief.
Weight stigma, just like racism or sexism or any other bias, is a form of oppression that tells people in larger bodies that they are morally wrong and socially unworthy. Many (and I would say most) people have internalized weight stigma and have therefore developed a fear of becoming/hatred of being fat. In a society that discriminates against fatness, this is pretty understandable. Internalized weight stigma usually manifests as body dissatisfaction.
Ok... but what about obesity?
Weight and risk for chronic disease are correlated, but there has never been any study that proves a causal link between obesity and disease risk, much less mortality. Drastic changes in weight over a short period of time can be a symptom that something is going on (like a thyroid issue, eating disorder, or other disease), but weight itself is a symptom, not a disease. We also know that there are many other risk factors for chronic disease like poverty and chronic stress,(1) lack of access to health care,(2) genetics, and childhood trauma.(3) Even among people classified as "overweight" or "obese" that do have a chronic disease like diabetes, their weight seems to actually be a protective factor against mortality.(4)
Fatness is not something to be cured or altered, and seeking to alter it is unsustainable. There is no existing weight loss diet that has proven, long-term results. Multiple studies have demonstrated that the majority of those on a diet and exercise regimen for weight loss gain back all or more of their original weight lost within 5 years.(4) The Women’s Health Initiative, a study including 20,000 people, demonstrated that even after eight years of sustained calorie deficit from diet, there was “almost no change in weight from starting point (a loss of 0.1 kg), and average waist circumference, which is a measure of abdominal fat, had increased (0.3 cm).”(4) It is estimated that only 5% of people in the US are able to sustain weight loss, and those that are able to do so use extreme, and arguably disordered methods.(5)
Because weight loss diets don’t work, many people try multiple times to diet, causing weight fluctuations known as weight cycling or yo-yo dieting. This process is itself associated with both higher weight gain over time and increased risk for chronic disease.(6,7) Furthermore, internalized weight stigma, or as explained above, the perceived societal pressure to be thin, is actually associated with increased caloric intake and worse chronic disease risk, as well as negative body image, low self-esteem, and depression.(8) In all, the negative metabolic and psychological impacts of dieting make weight loss an unethical prescription.(4)
What does work?
See that citation #4 I mention a bunch of times in the paragraphs above? That is a reference to a scientific paper on Health at Every Size by Linda Bacon and Lucy Aphramor. Instead of weight loss, which is futile and damaging, they propose a model in which healthy behaviors like going to the doctor or dentist, eating vegetables, exercising, and attending to mental health concerns are promoted for all people in all bodies. There have been some pretty amazing results from this weight-inclusive model. Check out the book Health at Every Size by Linda Bacon to dive in!
Intuitive Eating fits quite well into the weight-inclusive/HAES model, and in fact shares many of the same principles. The first one being "Reject the Diet Mentality," or in other words, toss weight loss out the window.
HAES model
I could write forever about HAES, but I want to highlight some work of fellow RDs-to-be and dietitians on the topic.
HAES and Public Health - Lindsay Koonce, grad student and dietetic intern
How to handle fatphobia at the doctor's office - Megan Price, dietetic intern
Weight stigma a the doctor - Madeleine White, dietetic intern
People are more than their bodies - Michelle Pillepich, grad student and dietetic intern
Body positivity on TV - Grace Greenfield, grad student and dietetic intern
Why how you feel is more important the what you weigh - Rachael Hartley, RD
How to know if Intuitive Eating is right for you - Haley Goodrich, RD
Done with Diet Culture - Cara Harbstreet, RD
Are weight and health linked? - Zeina Khawam, RD
Intuitive Eating and weight loss - Robyn Nohling, RD, FNP
Postpartum dieting - Lindsay Stenovec, RD
Diets in disguise - Kylie Mitchell, RD
Ditching diet culture
Ditching diet culture is not easy in the slightest. It is pervasive, and takes a significant amount of effort to evade. It requires standing up for your right to have a body that you treat with respect. And that in itself requires confidence. That's what I hope this blog can spark for you! I want to inspire you and connect you with the resources that inspire me. I like to think of being body positive as being like this sassy curvy cactus. Soak up and store inspiration to survive in the desert of diet culture, and use resources as your spines to protect yourself from harm.
Be a sassy cactus
If you feel like you are stuck in a cycle of deprivation and guilt, feel crazy around food, or feel like you've hit diet rock bottom and can't get out, consider talking to a Registered Dietitian.
You can also find a HAES RD here, or an RD who is a Certified Intuitive Eating Counselor here. If you suspect that you may have an eating disorder, visit this website to find help.
Books:
Intuitive Eating, 3rd Edition by Evelyn Tribole MS, RD and Elyse Resch MS, RD, FADA, CEDRD
Body Kindness by Rebecca Scritchfield, RDN
Health at Every Size by Linda Bacon, PhD
Body Respect by Linda Bacon, PhD
What's Wrong with Fat? by Abigail Saguy
EveryBody Yoga by Jessamyn Stanley
Fat: The Owner's Manual by Ragen Chastain
Podcasts:
These links are to great starter/overview episodes!
Other Blogs and Websites:
Association for Size Diversity and Health
Lucy Aphramor, Poet and Dietitian
Mindful Eating México - Recursos en Español
References:
Acabchuk RL, Kamath J, Salamone JD, Johnson BT. Stress and chronic illness: The inflammatory pathway. Soc Sci Med. 2017;185:166-170. doi:10.1016/j.socscimed.2017.04.039.
Douthit N, Kiv S, Dwolatzky T, Biswas S. Exposing some important barriers to health care access in the rural USA. Public Health. 2015;129(6):611-620. doi:10.1016/j.puhe.2015.04.001.
Chartier MJ, Walker JR, Naimark B. Separate and cumulative effects of adverse childhood experiences in predicting adult health and health care utilization. Child Abus Negl. 2010;34(6):454-464. doi:10.1016/j.chiabu.2009.09.020.
Bacon L, Aphramor L. Weight Science: Evaluating the Evidence for a Paradigm Shift. Nutr J. 2011;10(1):9. doi:10.1186/1475-2891-10-9.
Ikeda J, Amy NK, Ernsberger P, et al. The National Weight Control Registry: A Critique. J Nutr Educ Behav. 2005;37(4):203-205. doi:10.1016/S1499-4046(06)60247-9.
Olson MB, Kelsey SF, Bittner V, et al. Weight cycling and high-density lipoprotein cholesterol in women: Evidence of an adverse effect. A report from the NHLBI-sponsored WISE study. J Am Coll Cardiol. 2000;36(5):1565-1571. doi:10.1016/S0735-1097(00)00901-3.
Montani J-P, Viecelli AK, Prévot A, Dulloo AG. Weight cycling during growth and beyond as a risk factor for later cardiovascular diseases: the “repeated overshoot” theory. Int J Obes. 2006;30:S58-S66. doi:10.1038/sj.ijo.0803520.
Tylka TL, Annunziato RA, Burgard D, et al. The Weight-Inclusive versus Weight-Normative Approach to Health: Evaluating the Evidence for Prioritizing Well-Being over Weight Loss. J Obes. 2014;2014. doi:10.1155/2014/983495.