What Is Weight-Inclusive Healthcare?

WHAT IS WEIGHT-INCLUSIVE HEALTHCARE?

11/9/2024

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Learn more about the weight-inclusive approach to health and eating disorder recovery.

WRITTEN BY DANIELLE LITHWICK, MA, RP

As a psychotherapist in the field of eating disorders and disordered eating, I provide a weight-inclusive approach to treatment. To better understand what this means, let’s first define what it is and compare it to the weight-normative approach to care.

Weight-Normative vs. Weight-Inclusive Healthcare

Information in this section was taken from a research paper by Tylka et al. (2014) to help define and understand the differences between weight-normative and weight-inclusive healthcare.

Weight-Normative (also called “weight-centric”) Healthcare: Practices and principles that emphasize weight-management and weight-loss as the main determinant of health and well-being.

When a doctor or any other healthcare provider prescribes weight-loss as a treatment or solution to a medical condition, they are operating within the weight-normative approach. In our society and healthcare system, weight-normative care is unfortunately “the norm”, and likely the most familiar approach that you’re aware of or have experience with.

The weight-normative approach is based on the following assumptions:

That weight or BMI (Body Mass Index) is the main determinant of health.

That a higher weight or higher BMI causes disease.
That weight-loss is the main treatment or prevention of disease.
That significant weight-loss is largely achievable and sustainable.
That a person’s weight is largely in their control and that being at a higher weight is a personal failure to one’s health and a burden on society.
That there is only one “healthy” weight everyone should be striving for.

These assumptions are not based on evidence, are stigmatizing, and rooted in anti-fat bias, all of which can compromise and worsen one’s health (Tylka et al., 2014).

Weight-Inclusive Healthcare: A holistic view of health and well-being, with a focus on health promoting behaviours and practices regardless of one’s weight. Prescribing weight-loss or weight-management is not the focus of treatment. Instead the focus of treatment is on helping people make sustainable, fully-informed, and person-centered changes independent of one’s size or BMI.

Weight-inclusive care also means creating non-stigmatizing and accessible healthcare environments and practices for all body sizes, such as having hospital gowns and blood pressure cuffs that fit larger bodies, having waiting room chairs that can hold higher weight people, and not having BMI cutoffs for surgeries, to name only a few examples.

The weight-inclusive approach is based on the following assumptions:

That weight is not a behaviour, is largely out of our control, and not a good indicator of health, and therefore cannot be prescribed as a treatment in healthcare.
That improving one’s health and well-being can be pursued and achieved at any weight, given access to person-centered, non-stigmatizing health care.
That health is multifaceted and includes physical, mental, socioeconomic, and spiritual dimensions, not just a number on the scale.
That a patient is the expert of their own body, and their treatments and healthcare should be collaborative and adjusted to support their needs and preferences.
That body diversity exists and one’s health status cannot be determined by BMI or weight alone.
That there is empirical evidence that various health markers can be improved independent of weight.
That prescribing weight-loss as a treatment is unethical because there is no evidence that supports a weight-loss method that is sustainable and has any significant success in the long-term (more than five years).
That prescribing weight-loss as a treatment may put someone at higher risk of weight-cycling (ie. losing and gaining weight repeatedly) and/or developing an eating disorder, both of which can worsen one’s health.
That making the focus of treatment about weight-loss or weight-management is stigmatizing and can discourage patients from following-up if they have not achieved weight-loss, and therefore may miss getting diagnosed or help for serious health conditions.

These assumptions are supported by research that shows:

BMI (Body Mass Index) and weight are mostly poor indicators of health and that you can be in a larger body and healthy (and you can be in a thinner body and unhealthy).
That dieting doesn’t work for the majority of people in the long run and may actually increase the risks of health complications and developing eating disorders.
That weight discrimination in health care and in society is associated with increased stress and worse physical health and well-being.

The weight-inclusive approach is an evidence-based alternative to the stigmatizing and discriminatory weight-centric beliefs and health practices that are unfortunately regularly practiced in our fatphobic society. Focusing on how people can have a healthier relationship with food, their bodies, and themselves, such as self-care and stress management, social connection, self-compassion, honouring your hunger, eating foods that are satisfying and nourishing, moving your body for enjoyment and health, are all behaviours that can be practiced and changed. Weight-loss is not a behaviour, and therefore not really in our control to change. It is sometimes a result of certain behaviours or circumstances but focusing on weight-loss will often result in unhealthy behaviours and conditions, such as increased stress, disordered eating and internalized shame and stigma (Tylka et al., 2014).

Criticisms About Weight-Inclusive Care

Some critics claim that the weight-inclusive approach to healthcare is too extreme and promotes “obesity” (fyi, the word “obesity” is a stigmatizing term because it automatically categorizes people in larger bodies as “unhealthy” or as having a “disease”. So I don’t use the word “obesity” unless I’m quoting research or another source). But the weight-inclusive approach is not promoting “obesity” nor is it claiming that everyone in a larger body is healthy. The main premise of weight-inclusive care is that every body, whether larger or smaller, has a right to equal healthcare information, access and treatment and should not be discriminated against due to their weight. It acknowledges that the world is made up of diverse bodies of all shapes and sizes, and that this should be embraced and celebrated, instead of shamed and potentially harmed by unfounded notions that thinness equates to health. It acknowledges that health is not only determined by proper nutrition and joyful movement, but also by spiritual, mental, and emotional well-being, and by the socio-economic and political factors that affect access to healthcare and living a health-promoting lifestyle (*I will add that health is not a moral imperative, and just as one's body size should not determine their worth as a human, neither should their health status, or choice and/or ability to engage in health-promoting behaviours).

Weight-inclusive care is rooted in science and social justice that supports people of all body sizes to be able to pursue health in a way that minimizes harm and enhances well-being. I wonder, how can we really argue with this? How can we be OK with treating people in larger bodies differently than those in thinner bodies? How is it OK in our society to fat-shame people and judge someone’s worth or morality on their size? How is it OK to be “treating obesity” with diets that don’t actually work and may cause even more harm?
IT IS NOT OK.

How Is Weight-Inclusive Care Related To Healing Eating Disorders?

In light of full transparency, I only started to learn about the weight-inclusive approach to health in my early days as a therapist and training in the field of eating disorders, and it took some time for me to fully embrace it. In fact, in the midst of my own eating disorder, I fully believed that "thin = health" and that "thin = happiness". I was a part of fatphobia in society and grasped onto fatphobic beliefs. Unfortunately most eating disorders and disordered eating behaviours are rooted in a fear of being fat (and there are so many other factors that contribute to the development and maintenance of eating disorder behaviours that are beyond the scope of this post). But would this fear of being fat even exist if we actually celebrated size diversity and treated larger people the same way we treat thinner people?

Another reason why it may have taken time for me to fully understand the weight-inclusive approach to health is that I have a lot of body-privilege, including size privilege. Despite experiencing an eating disorder and weight fluctuations during my recovery, I am and always have been within a body size range that has a lot of privilege. This means that I have not experienced discrimination or stigma associated with my body size. Even though I rejected my tall, “big-boned” and “curvy” body as a child and teenager due to fatphobic beliefs passed down and perpetuated around me, I have never had any issues with finding clothes that fit, or sitting comfortably in an airplane seat, or have had a judgmental look from a doctor about my weight. Therefore I do not have lived experience of navigating the world in a larger body that has less privilege.

So when I talk about body acceptance or intuitive eating with a client in a larger body, who has been shamed by their doctor or family, who has been told over and over again that they need to lose weight to be healthy and happy, and who can’t fit in an airplane seat, I cannot say that I fully understand what that is like (well, I cannot say I fully understand anyone’s experience because we all have different experiences...but you know what I’m saying, I hope). And I’m not ever going to pretend that I know what that is like. Nor that it’s easy to just eat what you want or love and accept your body in a weight-centric, fatphobic world.
It’s not at all.

When I have a client in a larger body in my office tearing up when recalling their multiple struggles with weight-loss and weight-regain, and for being told that they are the "failure" and they should be ashamed for not being able to “control themselves”, or to “motivate” themselves to change their behaviours “for their health” over and over again, I know that our society’s weight-centric beliefs and weight-normative healthcare is not working and only causing harm. Moreover when I see clients of all body sizes entrenched in disordered eating and exercise habits, and plagued by body image distress everyday, it only confirms that our diet and thin-obsessed society is just really wrong.

After spending years working on my recovery, learning about the harms of dieting and weight-stigma, and engaging in professional training for the treatment for eating disorders, I now believe that weight-inclusive care is the most ethically and effectively sound approach in supporting people’s health and well-being. This is why I take this approach in my psychotherapy practice when it comes to helping people heal from eating and body image concerns.

PLEASE NOTE: For anyone that is struggling with the desire to lose weight in order to be "healthy and happy", I want to hold space for you and let you know that it’s totally understandable to have this desire in our fatphobic, weight-centric society. Most people that I see in my practice start with having a desire for weight-loss or a fear of weight gain. I do not hold any judgment about this and place the blame on society and systems, never on individuals. I also know that it may take time to understand and embrace the weight-inclusive approach to health and there may be a lot of valid obstacles and challenges to work through along the way. As a therapist, I strive to provide a place where you feel heard, seen, and validated and also want to provide an approach to health and recovery that is sustainable, effective, and that minimizes harm. I invite you to learn more about the weight-inclusive approach to care and see how it can support you in making the changes you want.

References:
Tylka, T. L., Annunziato, R. A., Burgard, D., Daníelsdóttir, S., Shuman, E., Davis, C., & 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, 983495. https://doi.org/10.1155/2014/983495

Resources to further your understanding of weight-inclusive healthcare:

HAES® (Health At Every Size®) Health Sheets here
Weight and Healthcare (newsletter) by Ragen Chastain here
Medical Students for Size Inclusivity here
Aubrey Gordon (books and podcast) here

Research Papers:

Do No Harm: Moving Beyond Weight Loss to Emphasize Physical Activity at Every Size here
Weight Loss Is Not the Answer: A Well-being Solution to the “Obesity Problem” here
Medicare's Search for Effective Obesity Treatments: Diets Are Not the Answer here
Weight Science: Evaluating the Evidence for a Paradigm Shift here
The Weight-Inclusive versus Weight-Normative Approach to Health: Evaluating the Evidence for Prioritizing Well-Being over Weight Loss here

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Disclaimer: Please note that the information in this or any other blog posts on this site is for educational purposes only and not meant to be a substitute for medical or psychological advice. Please consult your healthcare practitioner before making any changes. See full disclaimer here.