The Non-Diet Approach: A Student Dietitian’s Perspective
Meher is a Nutrition Science student at Deakin University. She has recently been introduced to the non-diet approach and completed Fiona Willer’s Introduction to the Non-Diet Approach course. In this blog post, she will be exploring how this course has changed her view on health and body size.
The non-diet approach aims to improve health outcomes through developing healthy habits to nourish the body. This is as opposed to focusing on weight loss, such as in the weight-centric approach.
For example, a non-diet dietitian would help clients work on increasing vegetable intake to improve gut health and reduce cholesterol levels, rather than focusing on how it’s low in calories. This approach emphasizes health gains rather than changing body size.
Vegetables: what health benefits do you focus on - nutrients for gut and heart health or calories for weight loss?
Currently, many health care providers still use the weight-centric approach, which means that patients are being treated based on their respective body weights and BMIs. As a result, patients may experience weight bias and may receive inappropriate medical interventions as a result of judgement of their body size. (1)
For example, health care workers may recommend weight-loss interventions rather than referring the patient living in a larger body for further investigation into their initial concerns. (1) This discrimination and weight stigma deters many patients in bigger bodies from continuing to seek proper medical advice. (1)
Have you ever felt fat shaming from your medical or health professional?
On the flip side, patients in smaller bodies are also negatively affected by this body profiling. Studies have shown that patients in smaller bodies may not be tested for conditions such as diabetes as they don’t fit the “typical” profile. (2) Under- and misdiagnosing patients based on their appearance can be harmful.
In my tertiary studies, I am taught to use the weight-centric approach, but this course has helped me realise some inconvenient truths.
Here are 3 ways the non-diet approach has shifted my perspectives around weight and health:
1. A person’s health is determined by their Body Mass Index (BMI).—> You cannot tell someone’s health status by looking at their BMI.
The BMI is one of the most misleading concepts in health. Click through for more.
We all come in different sizes. A healthy weight and BMI for one individual might not be healthy for another. One’s BMI or amount of body fat cannot predict one’s life expectancy nor health status. (3)
A review that aimed to analyze the effects of BMI on health found out that those who were overweight did NOT have a higher risk of dying early compared to others. (4) Similarly, having a high BMI also does not mean that you are more prone to developing chronic diseases such as heart disease and diabetes. (3)
2. If we and exercise the same way, our bodies will look alike. —> If we eat and move similarly, our bodies would still look different from each other.
Thin influencers often conflate the false message that thinness = health, leading people to chase after a smaller body in the name of health.
On social media, there are lots of advertisements on thin influencers selling meal plans and workout routines with their only “qualifications” being their “fit” bodies. The marketing message it implies is: “eat and exercise like me and you’ll look like me”.
Our obsession with dieting, weight loss and changing our bodies has been influenced by the AUD 477 million (5) and US USD 72 billion (6) diet industry. They make weight loss seem as simple as following a thin person’s diet and exercise routine.
This industry sells us weight loss pills, teas, fad diets and shakes that claims to make you lose weight fast. Yet the evidence shows that 95-98% of people who lose weight will fail to sustain it, and actually regain the weight within 1-5 years. (7)
Ironically, the pursuit of weight loss is associated with weight gain, poorer health outcomes, and relationship with food. (8)
In reality, everyone has different nutritional, movement and self-care needs and a one-size-fits-all approach doesn’t work for everyone. Instead, it will be more sustainable, enjoyable and healthful to focus on what works for you, as a unique individual, instead of trying to copy what works for others. As such, this is what’s encouraged in the non-diet approach.
3. The non-diet approach is anti-science and anti-health. —> The non-diet approach has been scientifically proven to have many benefits for physical and mental health.
Ironically, not focusing on weight has shown to improve physical and mental health markers and increased engagement in healthy behaviours.
Many people perceive the not dieting as being indulgent, undisciplined and not caring to engage in healthy behaviours, and that there is no scientific evidence to back it up. This is incorrect.
A recent study conducted in 144 women aimed to find out the effects of the non-diet approach on eating behaviours and appetite. This study found that the moving away from weight and body focus is associated with improved self-esteem, anxiety, mood, body image, and quality of life. (8)
Another review found that the non-diet approach is associated with improved blood cholesterol levels, blood pressure, nutritional variety and physical activity levels. (9)
My biggest takeaway lesson from this approach is to NEVER judge someone’s health based on one’s body shape and size. Instead, I would assess someone’s health based on biochemical markers such as blood pressure, blood sugar levels and micronutrient levels.
However, I still do not know where I sit between the non-diet and weight-centric approach as I am still learning about both. However, being introduced to the non-diet approach has definitely opened my eyes and changed many of my perspectives. I am intrigued to learn more about intuitive eating and its principles.
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References
1. Phelan, S.M., Burgess, D.J., Yeazel, M.W., Hellerstedt, W.L., Griffin, J.M., van Ryn, M. Impact of weight bias and stigma on quality of care and outcomes for patients with obesity. Obes Rev. 2015 Apr; 16(4): 319-326. Doi: 10.1111/or.12266
2. Tomiyama, A., Carr, D., Granberg, E. et al. How and why weight stigma drives the obesity ‘epidemic’ and harms health. BMC Med 16, 123 (2018). https://doi.org/10.1186/s12916-018-1116-5
3. Bacon L, Aphramor L. Weight science: evaluating the evidence for a paradigm shift. Nutr J. 2011 Jan 24; 10:9. Erratum in: Nutr J. 2011;10:69. https://doi.org/10.1186/1475-2891-10-9
4. Janssen I, Mark AE. Elevated body mass index and mortality risk in the elderly. Obes Rev. 2007 Jan;8(1):41-59. https://doi.org/10.1111/j.1467-789x.2006.00248.x
5. IBISWorld 2020, accessed 13 January 2021, < https://www.ibisworld.com/au/industry/weight-loss-services/1704/#:~:text=As%20a%20result%2C%20many%20Australians,%2D21%2C%20to%20%24466.2%20million.>
6. Statista 2020, Statista Research department, accessed 13 January 2021, < https://www.statista.com/topics/4392/diets-and-weight-loss-in-the-us/>
7. Lowe MR, Timko CA. Dieting: really harmful, merely ineffective or actually helpful? British J Nutr. Cambridge University Press; 2004;92(S1): S19–S22. https://doi.org/10.1079/BJN20041136
8. Provencher V, Bégin C, Tremblay A, Mongeau L, Boivin S, Lemieux S. Short-term effects of a "health-at-every-size" approach on eating behaviours and appetite ratings. Obesity (Silver Spring). 2007 Apr;15(4):957-66. https://doi.org/10.1038/oby.2007.638
9. Ulian MD, Aburad L, da Silva Oliveira MS, Poppe ACM, Sabatini F, Perez I, Gualano B, et al. Effects of health at every size interventions on health-related outcomes of people with overweight and obesity: a systematic review. Obes Rev. 2018 Dec;19(12):1659-1666. https://doi.org/10.1111/obr.12749
