EVIDENCE FOR A SHIFT IN FOCUS FROM DIETING AND WEIGHT LOSS TO HEALTH AND NATURAL FOOD REGULATION
Current guidelines recommend that "overweight" and "obese" individuals lose weight through engaging in lifestyle modification involving diet, exercise and other behaviour change. This approach reliably induces short term weight loss, but 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. Concern has arisen that this weight focus is not only ineffective at producing thinner, healthier bodies, but may also have unintended consequences, contributing to food and body preoccupation, repeated cycles of weight loss and regain, distraction from other personal health goals and wider health determinants, reduced self-esteem, eating disorders, other health decrement, and weight stigmatization and discrimination. This concern has drawn increased attention to the ethical implications of recommending treatment that may be ineffective or damaging.
A growing trans-disciplinary movement called Health at Every Size (HAES) challenges the value of promoting weight loss and dieting behaviour and argues for a shift in focus to weight-neutral outcomes. Randomized controlled clinical trials indicate that a HAES approach is associated with statistically and clinically relevant improvements in physiological measures (e.g., blood pressure, blood lipids), health behaviours (e.g., eating and activity habits, dietary quality), and psychosocial outcomes (such as self-esteem and body image), and that HAES achieves these health outcomes more successfully than weight loss treatment and without the contraindications associated with a weight focus. This paper evaluates the evidence and rationale that justifies shifting the health care paradigm from a conventional weight focus to HAES.
The health at every size approach enabled participants to maintain long-term behaviour change; the diet approach did not. Encouraging size acceptance, reduction in dieting behaviour, and heightened awareness and response to body signals resulted in improved health risk indicators for obese women.
Current public health policy recommends weight loss for obese individuals, and encourages energy-restricted diets. Others advocate an alternative, 'non-diet' approach which emphasizes eating in response to physiological cues (eg hunger and satiety) and enhancing body acceptance.
Results: Over a 1 yr period, a diet approach results in weight loss for those who complete the intervention (MOST DO NOT), while a non-diet approach does not (REMEMBER THAT THE MAJORITY OF DIETERS REGAIN THIS WEIGHT AND MORE). However, a non-diet approach can produce similar improvements in metabolic fitness, psychology and eating behaviour, while at the same time effectively minimizing the attrition common in diet programmes.
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