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.
The following is a brief commentary, I was asked to write for the Metro Newspaper on the recent decision to introduce a “self-esteem” badge for Girl Guides. It appeared in the May 15 edition of the Metro News Toronto:
Anyone interested in promoting the health of young girls is faced with a seemingly impossible challenge. On one hand, in recent years we have seen a dramatic increase in the incidence of eating disorders — now one of the most common and dangerous chronic condition in young women.
On the other hand, the obesity epidemic has also adversely affected girls and women, with unprecedented numbers developing excess weight and related health issues, ranging from polycystic ovary syndrome and infertility to Type 2 diabetes and sleep apnea.
While those concerned about eating disorders are careful to not reinforce a negative focus on body weight, those concerned about obesity are unsure how to broach this issue without further diminishing self-esteem. There is clearly concern about the unintended harmful consequences from overweight and obesity prevention initiatives, particularly those delivered in schools.
But overemphasis on weight or group weigh-ins can trigger fat prejudice, weight-based teasing, or the ostracizing of larger children, or, cause children to react to healthy eating messages by adopting extreme approaches to dieting and consequently losing weight to a degree that negatively impacts their health.
Perhaps the common ground lies in recognizing both eating disorders and obesity as psychosocial health issues. At one end of the spectrum girls and young women seek to control their weight by resorting to extreme dieting, excessive exercise and other destructive behaviours. At the other end, girls and young women turn to food to cope with negative emotions, stress, boredom, abandonment, emotional neglect and isolation.
Now, the Girl Guides of Canada have taken up the challenge of dealing with negative body image by introducing the Love Yourself Challenge badge, which girls aged five to 17 can earn by completing tasks that promote self-esteem, healthy eating and a positive body image.
Whether this initiative will indeed help to reduce the risk of eating disorders while promoting healthy weight remains to be seen. Increased self-esteem is clearly beneficial whether you are dealing with under- or overweight people.
The societal causes of eating disorders and obesity may well be the same: Media, advertising, disintegration of nuclear families, lack of role models, loss of control over an excessively demanding, stressful and fast-paced society that takes little time to play, eat or reflect on the things that truly matter in life.
Let us hope that the Girl Guides’ approach can manage to help girls walk the fine line between pathological dieting and numbing their emotions with food.
If it can help dissociate self-esteem from body weight, much will have been won.
Happy Victoria Day!