To Lose Weight or Not to Lose Weight? That is the Question
Americans are in an interesting predicament right now with their health. As a nation, we have never been fatter — 42% of Americans are considered obese with 9% of those being severely obese (1) . At the same time Americans are being told by their doctors to lose weight for their health, others are saying “hold up” your weight might not be as harmful as we once thought. What gives?
The Health At Every Size Movement Refutes that One’s Weight is a Problem
A movement known as Health at Every Size (HAES) challenges the idea that Americans need to shrink their body to be healthy. HAES was developed to reduce weight-stigma in health care and in turn ‘celebrate’ body diversity instead of feeling shame or self-hatred for not living up to certain thin ideal being perpetuated by diet culture. HAES encourages more than just feeling good about the body you inhabit, but treating it with self-compassion — by finding joy in physical movement and eating in a flexible manner that balances the pleasure of eating with honoring internal cues like satiety and hunger (2).
Anti-Diet Approaches Like Intuitive Eating are Gaining Momentum
Meanwhile, an anti-diet approach to eating, known as Intuitive Eating supports similar views to HAES. The authors of the book behind Intuitive Eating, argue health behaviors versus a person’s weight is a better predictor of health outcomes. Advocates of intuitive eating also say the traditional route for weight-loss (i.e., dieting) is worse than the perceived problem — being overweight. The authors of the book back up their claims with research to support that chronic dieting or yo-yo dieting is associated with a myriad of psychological and physical problems including reduced self-esteem, depression, obsessive thoughts about food, reduced metabolism, and increased risk for developing eating disorders (3).
Ditch Diets or Embrace the Body we Have?
As someone who has a history with dieting, I can attest that bouncing from one extreme diet to the next is a bad idea, to say the least. Nonetheless, does that mean Americans should do-away with all diets?
As a practicing Registered Dietitian and someone who cares deeply about my clients health, I don’t think so. Some people may think I have two options when a client comes to me and says, “I want to lose weight.” The first being — put them on an extreme diet that is going to send them into a tail-spin of disordered eating patterns OR second— encourage them to embrace body ‘self-love’ and turn a blind eye to the fact their weight puts them at risk for several chronic diseases?
I’ve thought long and hard about this, and I don’t think it comes down to an either/or but a both/and.
What Intuitive Eating and HAES Has Right
Intuitive Eating and HAES are great for instilling better mental health but not necessarily physical health.
Intuitive eating is not designed for weight-loss, it’s designed for healing your relationship with food and making peace with your body. Research conducted on intuitive eating versus traditional dieting shows while intuitive eating can improve psychological health indicators like self-esteem and body image — there is I limited evidence to support it helps someone lose weight or improves their diet quality (4).
And then there is HAES. I believe HAES intentions to reduce weight-stigma and promote equal treatment in health care for all sizes and shapes is admirable. Yet, I believe HAES is an idealistic model for health; it doesn’t reflect the reality that obesity is a threat to one’s health and the health care system at large.
Obesity Still Present Risks for the Majority of People
Obesity (defined as having a body mass index of > or equal to 30) remains the leading risk factor for developing type II diabetes. In fact, obese women are 28 times more likely to develop diabetes compared to women of normal weight. Both diabetes and obesity are independent risk factors for cardiovascular disease — which remains the leading cause of death in women (5). Furthermore, being overweight or obese puts you at risk for developing high blood pressure, certain cancers, sleep apnea, osteoarthritis, fatty liver disease, and pregnancy complications (6).
Lastly, if you have been paying attention to news on COVID-19, research has clearly indicated that obesity significantly worsens COVID-19 outcomes. CDC states that being obese may triple your risk of hospitalization due to a COVID-19 infection. This is because obesity impairs immune function and worsens lung capacity (7). In a recently JAMA study that included 5700 patients hospitalized for COVID-19, it showed that 42% of the patients were obese (8).
Can There be a Happy Medium When it Comes Health?
Obesity is a threat to one’s health; fad diets are too. However, there has to be a middle ground when it comes balancing nutrition and our body weight . Americans like to operate with an ‘all-or-nothing’ mentality when it comes to eating and their weight, yet it’s important take a balanced approach.
The term ‘diet’ has negative connotations because it associated with restriction, deprivation, and choking down tasteless food. However, not all diets lead to devastating mental or physical effects. And diets encouraging moderation as opposed to total elimination are likely going to be your best bet for overall health and sustainable weight loss.
Here are three common traits of various diets that shouldn’t be dismissed.
Incorporate the Good Parts of Diets, Leave the Rest.
Diets Provide Structure
I’m sure you are familiar with the phrase ‘if you fail to plan, you plan to fail.’ This applies to most goals including managing your weight. Generally, most people don’t make the best eating decisions when they haven’t planned ahead. When hunger strikes and you have nothing prepared to eat, you probably reach for the most convenient or quickest form of energy — and sorry to break it to you, but it’s likely not an apple.
Studies show increased meal planning is associated with greater weight-loss compared to those who meal plan less frequently. Unfortunately, intuitive eating (the anti-diet) doesn’t really lend itself to meal planning when you are supposed to feed your body based on what it wants in any given moment. In theory, intuitive eating is is a beautiful thing but from a practical stand point — eating whenever and whatever can be difficult given peoples busy, over-scheduled lives.
Most Diets Advocate for Eating More Whole Foods
No one can argue that eating more whole foods (fruits, vegetables, whole grains, nuts, seeds, beans) as opposed to highly-processed foods typically full of added sugar, salt, and unhealthy fats is a bad thing. Whole food plant-based diets tend to be effective for promoting weight-loss for a couple reasons.
Whole fruits and vegetables are a great source of fiber and water. Fiber is the non-digestible form of carbohydrate that has multiple super powers but as it applies to weight, fiber fills you up and helps prevent blood sugar spikes — both of which can prevent over-eating. Consuming high water content fruits and vegetables like watermelon, tomatoes, and grapes for example also hydrates your body which prevents thirst from masquerading as hunger.
Achieving a Calorie Deficit is at the Crux of Every Diet
What most diets do get right is that weight-loss is only achieved by hitting a calorie deficit at the end of the day. Calorie deficits are largely accomplish by increasing calorie output (movement/physical activity) or reducing calorie input (diet). Some diets reduce carbohydrates (e.g., keto or Atkins), whereas, others condense the window of time you are allowed to eat (e.g., intermittent fasting) which leads to fewer calories being consumed. But no matter the diet strategy, all aim to put your body into a calorie deficit with very few exceptions.
A diet which eliminates entire food groups or classes of macronutrients is something I would not advise for overall health and sustained weight-loss. However, it important for those wanting to lose weight to understand the energy density of the foods they are eating. That said, learning how to read food labels, track your calorie intake, and understand how portion sizes influence calorie intake are under-rated dietary strategies for losing weight. And no, this doesn’t mean you need to scrutinize every food label or track every calorie you consumer for the rest of your life. Yet once you have a general understanding of nutrition you can use this knowledge to inform dietary decisions long-term (not just when your diet is over).
To Sum it Up
Americans can’t continue to operate in extremes when it comes to eating or weight management. Diets and even ‘anti-diets’ like intuitive eating have some valuable take-ways when it comes to nourishing our bodies and minds. This means, ditch the fad diets that leave you feeling crazy and starved. But keep making healthy choices that are grounded in evidence-based nutrition-science. Your body will thank you.
You just read another post from In Fitness And In Health: a health and fitness community dedicated to sharing knowledge, lessons, and suggestions to living happier, healthier lives.
If you’d like to join our newsletter and receive more stories like this one, tap here.
