by Marsha Hudnall, MS, RD, CD
Do you know how many calories you ate for breakfast? Grams of carbohydrate and fat? Chances are, you have an idea if you’re the typical American who watches the scale fluctuate almost as uncontrollably as the Dow Jones Industrial Average.
For nearly half a century, weight control has captured the attention of Americans. Diet books consistently rank on bestseller lists; women’s magazine editors agree their publications wouldn’t sell as well without covers touting the latest weight loss scheme; diet doctors gain fame as their patients lose weight (and even as their patients regain ost weight); patrons flock to spas in search of answers to help them eat well, get active and stay slim. Yet that which we seek remains elusive. Americans appear to be getting only fatter.
Defining the Problem
Experts agree there are no easy answers to America’s struggle with weight. But a good place to start is by looking at physiological underpinnings that confuse many as they attempt to take care of themselves. Take the distinction between the weight gain of aging and that of an unhealthy lifestyle. True, it may be difficult to tease out the effect of each, especially in the aging couch potato, but it’s important to understand that a modest weight gain as we age may be healthy. Researchers at the National Center for Health Statistics, Centers for Disease Control and Prevention, recently examined 30-year data for the National Health and Nutrition Examination Survey studies from 1971- 2002 to compare risk of death associated with different levels of body mass index (BMI).(1) Published in the Journal of the American Medical Association, the study showed that people who are classified as ‘overweight’ (BMI between 25 and 29.9) live longer than those who qualify as ‘normal’ BMI (18.5 to 24.9). Not that BMI is necessarily associated with extra fat on the body; it fails to distinguish between fat and muscle tissue, evidenced by the fact that Arnold Schwarzenegger is officially classified as obese at a BMI of 33 and George Clooney is overweight at a BMI of 29. In other cases, however, higher BMIs do mean more fat on the body, but rather than unhealthy lifestyles, the extra fat may be a factor of genetics, gender, race, ethnicity or age. In today’s society, though, fatter bodies for any reason are anathema to idealized images of beauty, which has been a key player in healthy lifestyle struggles for many women and, increasingly, men.
According to a report from the Trust for America’s Health, the obesity rate increased in 31 states compared with last year. Mississippi has the highest obesity rate at 205 percent; Colorado’s 16 percent is the lowest.
Cycle of Dieting
Cycle of Eating
HAES has a ‘health-centered’ focus as opposed to a ‘weight-centered’ one.
That idealized image clearly plays an important role in Americans’ struggles with weight and health. The fact is that
healthy bodies come in all sizes. Yet in an attempt to circumvent biological realities, we begin dieting, often evolving to a starve/binge cycle that results in higher weights than we started with. To say nothing of the psychological toll dieting takes as we fail in attempt after attempt to lose weight and keep it off. Or the fact that individual calorie requirements and expenditure can’t be determined with a formula or chart. Or that a focus on calories or individual nutrients only serves to distract people from using natural body cues to guide eating, which many experts agree offers the best approach for eating for health and healthy weights.
Today’s typical lifestyles undoubtedly play a major role also. What, when and where we eat all affect choices, often leading to unbalanced, less than nutritious meals and snacks that fail to truly nourish. Further, such eating plans fall short when it comes to providing support for physical activity, which is important to maintaining healthy weights.
Tackling the Problem
Traditional methods for weight loss, whether they be utilized in medical settings or commercial programs, have failed to provide true solutions. And cookie-cutter approaches like popular diets, or the inadequate although well-intended advice to just ‘eat less, exercise more,’ hold little chance for achieving and maintaining healthy weights. Further, dieting has only made people fatter and unhealthier, setting us up for eating styles that do not support health, distracting us from physical activity for health’s sake, and creating feelings of shame, lowered self-esteem and a general sense of failure that adds to the problem. Now is the time for dramatic change to reframe the conversation about weight, to take a long-term view of what really works to achieve and maintain health and healthy weights. A concept to consider is called Health at Every Size (HAES).
HAES has a ‘health-centered’ focus as opposed to a ‘weightcentered’ one. It recognizes widespread attitudes that contribute to the behaviors that create and exacerbate struggles with achieving and maintaining health and healthy weights. Those attitudes include seemingly basic beliefs such as successful weight management is ‘all about calories in vs. calories out,’ or just being ‘good,’ or that we can all be thin, or even all need to be thin to be healthy. The tenets of the movement guide professionals and consumers in beginning to think and act differently to achieve health and well-being, and accept the healthy bodies that result regardless of size.(2) They include:
Health enhancement—paying attention to emotional, physical and spiritual well-being without a focus on weight loss or achieving a specific ‘ideal weight’
Size and self-acceptance—respect and appreciation for the diversity of body shapes and sizes, rather than the pursuit of an idealized weight or shape
Pleasurable eating—eating based on internal cues of hunger, satiety and appetite, rather than on external food plans or diets.
Joyful movement—encouraging all physical activities for the associated pleasure and health benefits, rather than following a specific routine of regimented exercise for the primary purpose of weight loss
An end to weight bias—recognition that body shape, size and/or weight are not evidence of any particular way of eating, level of physical activity, personality, psychological issue or moral character
1- Flegal, K.M., Graubard, B.I., et al. “Excess Deaths Associated with Underweight, Overweight and Obesity,” Journal of the American Medical Association, 2005; 293:1861-1867.
2- Tenets adapted by Karin Kratina, MA, RD, LD, and Ellen Shuman, from original tenets published in Moving Away from Diets, Helm Publishing, 1996.
ABOUT THE AUTHOR
Marsha Hudnall, MS, RD, CD is program director for Green Mountain at Fox Run, a women’s residential weight
management retreat now in its 35th year. Green Mountain is a pioneer in the HAES approach, and offers the country’s oldest “non-diet” program to help women establish healthy relationships with food, eating behaviors and their bodies by providing lifestyle strategies that can be integrated into their busy lives. Marsha can be reached at email@example.com or 800-448-8106. Learn more at www.fitwoman.com.
HAES in Practice Health at Every Size
Avoid admonitions to lose weight Positive change comes from self-acceptance and self-love, not from self-loathing
Respect for diversity is for everyone Very difficult to teach without doing our own work
Fat does not necessarily mean unfit
Do not associate physical activity with weight loss or calorie burning
Physical activity as “caretaking” – “to move the body, not change the body”
Encourage physical activity, not just exercise
Internally Directed Eating
Listening to appetite, hunger and satiety cues
Can be relearned by teaching awareness
No “good” or “bad” foods
Food nourishes the body, mind and spirit
Health vs.Weight-Centered Care
Avoid size-related assumptions
Discuss weight and body image concerns with people of all sizes
Focus on well-being, energy level, lipids, glucose, etc., rather than weight
Provide concrete reasons not to diet while offering the HAES alternative
Health vs.Weight-Centered Outcomes
Improved quality of life and self-acceptance
Amelioration of medical problems and decreased reliance on medications
Increased participation in and pleasure from physical activity
Increased use of internally-directed eating style and decreased obsession with food
- Robison, J. (2006). Health at Every Size: Shifting The Focus to Health. WELCOA’s Absolute Advantage Magazine, 5(3): 8-13.
The spa environment is well-suited for helping individuals to reframe their beliefs and attitudes, to reposition the search for healthy weights as an issue of health rather than one of eating or body size. The challenge is for spas to make the philosophical and financial investment in the necessary resources to offer fresh, exciting approaches that blend both the science and art of healthy living to help people achieve a balanced lifestyle.