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Weight Acceptance Prevents Weight Gain?



This may sound counterintuitive, but it appears that one way to manage your weight and not continue packing on more pounds year after year may be to simply accept your body weight for what it is and, instead of trying to lose weight, to simply focus on healthy behaviours.

As readers of these pages are probably well aware, the long-term results of restrictive weight-loss interventions is indeed rather disappointing. Thus, the advice to simply eat less, although associated with weight loss in the short term, is rarely sustainable and inadvertently leads to weight regain in the vast majority of patients.

Possible reasons why restrictive dieting often fails is because dieting can increase appetite and promote obsessive thoughts about food and eating as well as increase the risk of depression and overeating in response to negative emotions and stress.

In contrast to this restrictive “weight-centred” approach, a more “health-centered” approach, commonly referred to as “Health-At-Every-Size” (HAES), is based on the notion that health is related to behaviours independently of body weight. Thus, rather than considering weight loss the primary goal, the HAES approach focuses on promoting overall health benefits of behavior changes related to dietary habits and physical activity, with an emphasis on size acceptance and nondieting.

But does this approach provide a viable alternative to weight management?

This question was now addressed in a study by Veronique Provencher and colleagues from Laval University, Quebec, published in the Journal of the American Dietetic Association.

In this study, 144 premenopausal overweight/obese women were randomly assigned to either a HAES group, a social support group, or a control group. The HAES intervention consisted of 13 weekly 3 hour sessions and one intensive 1-day session conducted in small groups led by a registered dietitian and a clinical psychologist. The focus was on well-being and a positive healthy lifestyle as well as to impart awareness and knowledge about biological, psychological, and sociocultural aspects of body weight. In the HAES group, the interveners were active leaders, providing specific information and
structured activities to participants.

In contrast, the social support group, which met as often and discussed the same topics as the HAES group, was not specifically directed by the facilitators in terms of content or direction of the discussion. The main function of this group was to mimic the social support and network provided by the HAES group.

The control group consisted of a “waiting list” group, which was not offered any specific intervention at all.

Over the 16 month observation period, situational susceptibility to disinhibition and susceptibility to hunger significantly decreased over time in both the HAES and social support groups, but this difference appeared to be more sustained in the HAES group.

Although, women in the HAES group were not expected to restrict caloric intake, 63.4% of these women had a modestly reduced body weight at 16 months. In contrast, lower body weights were noted in at 16 months in 57.6% of women in the SS group and 43.7% of women in the control group. Significant associations were observed between eating behaviors changes and body weight changes only in the HAES group.

Thus, this study shows that a HAES approach may have long-term beneficial effects in terms of disinhibition and hunger, important behavioural components of healthy ingestive behaviour. Whether or not this approach will translate into better outcomes and long-term prevention of weight gain remains to be seen. It certainly seems to provide a viable alternative to anyone tired of endless weight cycling.

AMS
Edmonton, Alberta

10 Comments

  1. Glad to see of your interest in this topic. For more information about Health at Every Size and to connect with others, check out the (free) Health at Every Size Community Resources at http://www.HAESCommunity.Org. There has been a lot more research published on Health at Every Size; you can find links to the research my colleagues and I have conducted by looking through the resources on my private website: http://www.LindaBacon.Org. I’ve also written a book entitled Health at Every Size; more info about the book can be found at http://www.HAESbook.com.

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  2. I wonder if the HAES professionals told participants about the raised hypometabolic state threshold that Dr Sharma blogged about on Oct 26.

    It’s one of the most important biological aspects of weight gain.

    The common idea is that after you loose weight, you’re back to the way you were before, except maybe with a cosmetic problem of saggier skin.

    If I understand the blog correctly:
    In reality, while at a higher weight, your body suffers irreversible metabolic damage. When you then get down to a lower weight, the damage to metabolism is still there, invisible, affecting all your efforts to control your weight. This is permanent.

    (This isn’t the same as the common (non-medical) idea of a weight-loss plateau. The common idea of a plateau is that it is only a temporary phase, you get through it, and then you are back to usual weight loss.)

    Raising the weight threshold for hypometabolic state should be just as well-known as other complications of obesity, like diabetes.

    It’s easy to have that extra treat if you rationalize to yourself “I can loose the weight later”.
    It’s not so easy to rationalize “If I eat this, I will gain weight, and I will #$%$@ my metabolism so that in the future I will no longer be ABLE to loose weight.”

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  3. This is something that I see regularly at our clinic.

    The idea …”If I really hate my body, I’ll work harder to lose weight.”
    This notion is fueled further by television programs such as the Biggest Loser.

    My explanation to clients is that weight loss comes down to eating well and being active. These things hinge on the very fact that you FEEL GOOD about yourself.

    Unfortunately, a negative body image is associated with a negative self worth.
    Great work Linda and great job keeping us in the loop Arya.

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  4. Congratulations on taking this brave and bold stance. It is time to tell people the truth – dieting is usually a temporary fix with weight regain almost inevitable. Instead people can improve their health by improving their dietary intake and becoming more physically active. Rather than focus on weight loss, people need to focus on reliable indicators of health – blood pressure; serum HDLs, LDLs, cholesterol; c-reactive protein; insulin resistance; and blood glucose levels. Research shows that this metabolic indicators of health can be improved with changes in lifestyle and without weight loss. Joanne Ikeda, MA, RD, Nutritionist Emeritus, Department of Nutritional Sciences, University of California, Berkeley.

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  5. Thank you Dr. Sharma!

    For the last decade I’ve felt a bit lonely among my physician colleagues, many of whom promote dieting despite failure rates and complications that would never get a pharmaceutical product to market. Seems that many physicians and other healthcare professions feel that the end justifies the means – but they blame the patients’ lack of willpower, self-contol, compliance or other such personal faults when they are unable to reach or sustain the end.

    It is about time that we acknowledge that the diet paradigm is just too flawed to fix. Instead we MUST focus on health at EVERY size!

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  6. Dr Sharma, don’t give up the research on finding ways to actually loose weight and ways to prevent obesity.

    Being 100 lbs overweight is disabling, no matter how upbeat someone tries to be.
    Coping with this and being as healthy as possible is good.

    But pretending 100 lbs overweight is just fine is a worse lie than pretending a quick and easy diet will make weight disappear forever.

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  7. I think incorporating the ideas of Health at Every Size into treatment strategies can be profoundly impactful. Thinking about it as a way to stabilize weight and prevent weight gain (by preventing repeated weight loss attempts that drive weight higher) is a great way to go. If people who had the genetic propensity to gain weight easily and to retain that weight practiced HAES, imagine how much healthier our population could be (and how those looking to exploit people driven to lose weight would be out of luck).

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  8. It’s quite true what wellroundedtype2 true says, HAES has benefits and can prevent obesity from worsening.

    But there’s still the problem of “repeated weight loss attempts that drive weight higher”.
    Knowing what doesn’t work is a basis for furthering research in weight loss, not giving up completely.

    Today we have treatments for many conditions that were previously disabling. These effective treatments came after many false starts, dead ends, inaccurate understandings, and treatments that proved ineffective. Preventing obesity is best, but when that fails, long term weight loss is worth researching.

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  9. to Drew Harvey:

    IF your comment was to me and my avoiding food to not ^$%$# !!! my metabolism, I’m not acting out of self-hatred.

    What I was talking about was an EXTRA TREAT, not good food necessary for a healthy, weight-maintaining diet (or “food plan” if you don’t like the word “diet”)

    That EXTRA TREAT can be rationalized if you say “I can loose it later”
    That EXTRA TREAT can’t be rationalized if you say to yourself “if I eat this not only will I gain weight, I’ll raise the weight below which I will be in a hypometabolic state and then it will be very difficult, if not impossible, for me to loose the weight below the new threshold to get back to my present weight.

    Of course, if you rarely eat extra treats, and you always do loose an extra couple of pounds as soon as you gain them, you’ll have no problem.

    However, extra treats can add up really fast. An extra 100 calories a day is 36,500 cals a year – 10 lbs. A 100 calorie treat is advertised as if 100 calories is not worth bothering about. Then, suppose you’re a busy working parent with all sorts of things to deal with – in less than 2 years you’re 20 lbs overweight. For a short middle-aged moderately active woman, that is a significant amount of weight. I think that might very well be enough weight to negatively affect metabolism.

    So that is why I say beware EXTRA TREATS and know you might be getting yourself into more trouble than you realize.

    That’s not self-hatred. Quite the contrary, that’s taking care of yourself.

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  10. Knowing what doesn’t work is a basis for furthering research in weight loss, not giving up completely.

    Wow! Something I can agree with. I’d love to hear an explanation as to why the professionals aren’t learning from the obvious failure of all forms of calorie manipulation. In order to find out how to bring about the weight loss they so desire.

    It’s almost as if they don’t want to, maybe they like things just as they are.

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