This is such a valid question and deserves time to explore it.
You may be wondering if it is appropriate to work with an Eat Love Live (ELL) dietitian if you are unhappy with your body and would like to lose weight? You may be a practitioner who is unsure if it is appropriate to refer clients for weight management.
At ELL we use a lot of language and phrases like weight inclusive, non diet, HAES etc which you may or may not be familiar with.
Basically they all boil down to centering the clients needs and respecting the client. Reducing the possibility of harm, and embodying the values of our practice in actions such as informed consent, informed decision making and body autonomy.
In short - yes, you can come to ELL or refer clients to us who are seeking weight management.
However, the long answer is that we won’t prescribe restrictive diets, do weighing or measures, or focus on, or celebrate weight loss.
Despite years of research and billions of dollars there is no evidence based interventions that leads to long term weight management. This is acknowledged by the Clinical Practice Guidelines for the Management of Overweight and Obesity in Adults, Adolescents and Children, citing level A evidence to support this statement (1).
Weight cycling from repeated dieting has been shown to lead to increased weight, increased fat mass, inflammation, poor mental health, eating disorders, and significantly increased risk of development of type 2 diabetes, hypertension, and coronary heart disease (2,3,4,5,6,7,8).
Weight is only linked to poor health outcomes at very high BMI levels. Weight is often conflated as the cause of disease.
Weight and disease risk are often seen together but the confounding factors are the health behaviors, which can be targeted, changed, and disease risk improved regardless of change in body size.
Evidence shows us that health and disease risk can be can be improved by focusing on ( 9-14):
- Including fruit and vegetables ( regardless of other foods consumed) and food variety
- Moderate alcohol
- Social connection, hobbies and social groups
- Adequate sleep
Irrelevant of changes in body size or composition; as monitored by clinical markers such as blood results, Bp, fitness levels and client reported well being.
So then, what will we do?
As all ELL dietitians are excellent at supporting people with eating disorders they have well developed counselling skills.
Think of us as nutrition counselors.
We support clients to connect with and understand their body, the complexity of health, nutrition, diet culture and establish controllable, measurable goals to move towards improved health and mitigating disease risk .
We are able to hold space for people to talk about their experience in their body. Maybe, their experiences of being in a higher weight body the impact this has had on their life.
We can help them to understand the multi faceted impacts on body weight and start to decrease the shame that it is all their fault or other messages they have received throughout their life..
We can help them to understand what is and is not in their control to change their body and their health. To have realistic goals, and appreciate what long term changes may look like.
We can help clients understand what are normal and expected changes in body shape and size through the lifespan.
We can explore ambivalence and help to move them forward to a place of change.
We can focus on evidence supported interventions to improve blood pressure, BGL, Cholesterol, sleep, energy and feelings of wellbeing.
We are not anti weight loss...
- We are anti the diet culture and systemic structures that make people feel like their body needs to fit a particular mold to prove their worth.
- We are anti short term interventions that fail and leave people feeling worse.
- We are anti creating further shame and harm for people who have experienced weight stigma.
- We are about providing people with as much information as possible and allowing them to make an informed decision. And we respect the decisions people make about their own bodies when they have all the information.
- National Health and Medical Research Council. Clinical practice guidelines for the management of overweight and obesity in adults, adolescents and children in Australia. Melbourne: National Health and Medical Research Council.; 2013. p. 160.
- Mee Kyoung Kim et al., Associations of Variability in Blood Pressure, Glucose and Cholesterol Concentrations, and Body Mass Index With Mortality and Cardiovascular Outcomes in the General Population.Circulation. 2018;138:2627–2637
- Kajioka T et al.. Effects of intentional weight cycling on non-obese young women. Metabolism. 2002 Feb;51(2):149-54. doi: 10.1053/meta.2002.29976. PMID: 11833040.
- Blair SN et al.. Body weight change, all-cause mortality, and cause-specific mortality in the Multiple Risk Factor Intervention Trial. Ann Intern Med. 1993 Oct 1;119(7 Pt 2):749-57. doi: 10.7326/0003-4819-119-7_part_2-199310011-00024. PMID: 8363210.
- Montani JP et al. Weight cycling during growth and beyond as a risk factor for later cardiovascular diseases: the 'repeated overshoot' theory. Int J Obes (Lond). 2006 Dec;30 Suppl 4:S58-66. doi: 10.1038/sj.ijo.0803520. Erratum in: Int J Obes (Lond). 2010 Jul;34(7):1230. PMID: 17133237.
- Park SY et al. Weight change in older adults and mortality: the Multiethnic Cohort Study. Int J Obes 42, 205–212 (2018). https://doi.org/10.1038/ijo.2017.188
- Stevens J et al. Long- and Short-term Weight Change and Incident Coronary Heart Disease and Ischemic Stroke: The Atherosclerosis Risk in Communities Study, American Journal of Epidemiology, Volume 178, Issue 2, 15 July 2013, Pages 239–248, https://doi.org/10.1093/aje/kws461
- Van Loan MD, Keim NL. Influence of cognitive eating restraint on total-body measurements of bone mineral density and bone mineral content in premenopausal women aged 18-45 y: a cross-sectional study. Am J Clin Nutr. 2000 Sep;72(3):837-43. doi: 10.1093/ajcn/72.3.837. PMID: 10966907.
- Matheson EM, King DE, Everett CJ. Healthy lifestyle habits and mortality in overweight and obese individuals. The Journal of the American Board of Family Medicine. 2012 Jan 1;25(1):9-15.
- Khaw K-T, Wareham N, Bingham S, Welch A, Luben R, Day N (2008) Combined Impact of Health Behaviours and Mortality in Men and Women: The EPIC-Norfolk Prospective Population Study. PLoS Med 5(1): e12. doi:10.1371/journal.pmed.0050012
- Russell J, Flood V, Rochtchina E, Gopinath B, Allman-Farinelli M, Bauman A, Mitchell P. Adherence to dietary guidelines and 15-year risk of all-cause mortality. British Journal of Nutrition. 2013 Feb 14;109(03):547-55.
- Ekelund, Ulf, et al. "Physical activity and all-cause mortality across levels of overall and abdominal adiposity in European men and women: the European Prospective Investigation into Cancer and Nutrition Study (EPIC)." The American journal of clinical nutrition 101.3 (2015): 613-621.
- Wang Xia, Ouyang Yingying, Liu Jun, Zhu Minmin, Zhao Gang, Bao Wei et al. Fruit and vegetable consumption and mortality from all causes, cardiovascular disease, and cancer: systematic review and dose-response meta-analysis of prospective cohort studies BMJ 2014; 349 :g4490