On Nutrition

As terms like “non-diet,” “anti-diet,” and “Health at Every Size” show up more and more, and registered dietitians, therapists and other health-care providers adopt a “non-diet” approach, I’m hearing one question a lot: “Everyone eats some type of diet, so how can anyone be anti-diet?”

Well, what’s a diet?

Per dictionary definition, the word “diet” can mean “food and drink regularly provided or consumed” or “habitual nourishment.” It can also mean “the kind and amount of food prescribed for a special reason,” such as a low-sodium diet, or “a regimen of eating and drinking sparingly so as to reduce one’s weight.”

When someone says they’re anti-diet or use a nondiet approach, they are referring to weight-loss diets, not “habitual nourishment.” While they don’t support restrictive diets for weight loss or other nonmedical reason, they do support eating for health and well-being. Unfortunately, “anti-diet” and “non-diet,” along with terms like “wellness” and “lifestyle changes,” are increasingly being co-opted by individuals or companies who are actually promoting the opposite: weight loss.

Another question I hear? “If not dieting, then what?”

The nondiet and anti-diet philosophies stem from an alternative to dieting: Health At Every Size, or HAES, a trademark of the Association for Size Diversity and Health. Like anything that challenges the notion that “weight = health,” HAES is frequently misinterpreted or misrepresented.

Allow me to debunk some common HAES myths.

Myth: HAES means that everyone is healthy regardless of weight. The fact is that HAES advocates would say that people of all sizes struggle with illness and disease, and some people are not at a weight that’s right for them. However, dieting is not the answer, for a number of reasons. Research has found associations between dieting and disordered-eating behaviors — meal skipping, severe food restriction, purging, obsessive food thoughts — or even to actual eating disorders in susceptible people. Also, most people who lose weight don’t keep it all off for the long term, no matter what type of diet they followed. Chronic dieters who lose and regain repeatedly may end up at a higher weight than if they had never dieted.

HAES supports people in choosing health behaviors that are sustainable and improve quality of life, regardless of what they weigh or their current level of health. HAES also points out that health is multifaceted and includes physical, social, spiritual, occupational, emotional and intellectual aspects. Our physical health, specifically, is shaped by not just diet and lifestyle factors, but also our genetics and early childhood development, as well as our socioeconomic status.

Myth: HAES is anti-weight loss. The fact is that while a HAES approach does not support the intentional pursuit of weight loss, because obsessing over weight often causes more harm than good, it views weight loss itself as neither good nor bad.

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HAES takes the focus off weight and places it on behaviors that have been shown to benefit health all by themselves. HAES promotes eating in a way that balances individual nutritional needs, hunger, satiety, appetite and pleasure — in other words, intuitive eating. On the exercise front, a HAES approach would encourage finding types of physical activity that you enjoy and feel good to you, then working them into your life in a manageable way. It would not endorse dragging yourself out of bed every morning to go to the gym if that’s your idea of hell.

This decoupling of food and physical activity from the goal of weight loss is important because if the primary motivation for changing habits is weight loss, and the needle on the scale doesn’t budge, or it goes down — and then back up — the motivation to continue to eat well and exercise often fizzles.

Myth: HAES is about “giving up” and promoting obesity. HAES principles were initiated within the fat-acceptance movement, but they apply to every body type and size. People of all sizes can become preoccupied with controlling their weight in the name of health, and HAES offers a more peaceful path to adopting food and lifestyle habits shown to support health.

Consider this: When people lose weight by eating better and exercising more, the weight loss gets the credit for any health improvements, even though research has separately established that physical activity and good nutrition alone can improve health. Compared with weight-loss dieters, research also shows that individuals who adopt a HAES approach experience better health outcomes — such as lowered blood pressure and cholesterol levels, better body image and fewer disordered-eating behaviors — even when they don’t lose any weight.

HAES practitioners advocate for weight inclusivity, which means accepting and respecting the diversity of body shapes and sizes that naturally occur among humans, without idealizing or pathologizing certain weights. They also point out that everyone deserves respect and access to health care, regardless of size. The unfortunate reality is that weight bias, stigma and discrimination are rampant in society — including in health care.

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Weight bias from health-care providers reduces access to appropriate, evidenced-based care. Even when people lose an amount of weight intended to bring about health improvements — anywhere from 3 to 10 percent of highest weight — they may still be considered “overweight” or “obese” range — and still subjected to weight bias. And weight bias — as with other forms of bias — has been shown to directly harm health by increasing stress and contributing to chronic inflammation.

Final food for thought? We have direct control over our behaviors, but not over potential outcomes of those behaviors. How we eat, move and take care of ourselves are behaviors; what our weight does or doesn’t do is an outcome influenced by factors beyond our control. So decide where you’ll get the most value from your efforts.