Body Liberation Fits in Public Health, Reason #4

Working in a more weight-inclusive way aligns well with basic public health principles and goals. In many cases, a body liberation approach enables us to be truer to the values that underlie our work. In this series of posts, we will examine ways we can improve our public health work by becoming more weight-inclusive.

Reason #4: We Use Best Practices

The Body Mass Index:
The BMI is not a reliable indicator or predictor of health. It is simply a weight/height ratio with many assumptions about what that ratio means. Many people have researched and written about the issues with the BMI, including its racist origins and problematic assumptions about weight and health (Bacon & Aphramor, 2011; Gordon, 2019, 2023; Strings, 2019). In addition, focus on the BMI as a health indicator does not take into account the impacts of the social determinants of health or the influence of genetics. There are many other more accurate indicators and predictors of health and well-being, including biomarkers, social connections, stress levels, access to health-enhancing resources, exposure to toxic environments, etc.

Intentional weight loss:
In the majority of cases, dieting (intentional food restriction) does not lead to sustained weight reduction (Chastain, 2021; Mann et al., 2007). The articles listed below are examples of the extensive research on how our traditional approaches to weight and health have been at best ineffective, and more likely harmful and counter-productive. In fact, in 2007, Mann et al, after an extensive review of the effectiveness of dieting for sustained weight loss concluded:

“It is clear that dieting does not lead to sustained weight loss in the majority of individuals, and additional studies of the effects of dieting on weight are not needed. A call for more rigorous diet studies seems unwarranted as it has been noted that among diet studies, “greater methodological rigor seems to be associated with poorer results” (Kramer et al., 1989, p. 126). We do not think further study of existing diets will lead to a different assessment, nor do we think a new diet formulation will appear that leads to more favorable outcomes.” (p 230)

Kramer, F. M., Jeffery, R. W., Forster, J. L., & Snell, M. K. (1989). Long-term follow-up of behavioral treatment for obesity: Patterns of weight regain among men and women. International Journal of Obesity, 13, 123–136.

In addition to being mostly ineffective for sustained weight loss, dieting is related to increased rates of eating disorders (diagnosed) and disordered eating in general, especially for those who begin a pattern of dieting early in life. Weight loss recommendations are not benign. Stigmatizing and shaming are not good for health or motivation to change (Dennett, MPH, RDN, CD, 2018; Hunger et al., 2015; Pause’, 2017; Puhl & Heuer, 2010).

For multiple reasons, recommending intentional weight loss does not meet the standard for a best practice, and has the potential to cause harm. Public health campaigns aimed at individual behaviors, should focus on a variety of behaviors that research shows will improve health, such as eating nutrient-dense foods, moderate exercise, getting enough sleep, deepening social connections, etc. These can all be done with a weight-neutral approach and a focus on sustainability (Hunger et al., 2020; Tylka et al., 2014).

Ideally, public health campaigns focus on the environmental, economic and social factors that impact health more than individual behaviors.

ALLY ACTION

When someone brings up a weight-focused idea or plan for improving health (for themselves or others), shift the discussion to weight-neutral health markers, behaviors or resources.

CURIOUS TO LEARN MORE?

Bacon, L., & Aphramor, L. (2011). Weight Science: Evaluating the Evidence for a Paradigm Shift. Nutrition Journal, 10(1),
Chastain, R. (2021, November 6). Who Says Dieting Fails Most Of The Time? [Substack newsletter]. Weight and Healthcare Newsletter.
Dennett, MPH, RDN, CD, C. (2018, January). The Health Impact of Weight Stigma. Today’s Dietitian Magazine, 20(1), 24.
Gordon, A. (2019, October 18). The Bizarre and Racist History of the BMI. Medium.
Gordon, A. (2023). “You Just Need to Lose Weight” and 19 Other Myths About Fat People. Beacon Press.
Hunger, J. M., Major, B., Blodorn, A., & Miller, C. T. (2015). Weighed down by stigma: How weight-based social identity threat contributes to weight gain and poor health. Social and Personality Psychology Compass, 9(6), 255–268.
Hunger, J. M., Smith, J. P., & Tomiyama, A. J. (2020). An Evidence‐Based Rationale for Adopting Weight‐Inclusive Health Policy. Social Issues and Policy Review, 14(1), 73–107.
Mann, T., Tomiyama, A. J., Westling, E., Lew, A.-M., Samuels, B., & Chatman, J. (2007). Medicare’s search for effective obesity treatments: Diets are not the answer. American Psychologist, 62, 220–233.
Pause’, C. (2017). Borderline: The Ethics of Fat Stigma in Public Health. The Journal of Law, Medicine & Ethics, 45(4), 510–517.
Puhl, R. M., & Heuer, C. A. (2010). Obesity Stigma: Important Considerations for Public Health. American Journal of Public Health, 100(6), 1019–1028.
Strings, S. (2019). Fearing the Black Body: The Racial Origins of Fat Phobia. New York University Press.
Tylka, T. L., Annunziato, R. A., Burgard, D., Daníelsdóttir, S., Shuman, E., Davis, C., & Calogero, R. M. (2014). The Weight-Inclusive versus Weight-Normative Approach to Health: Evaluating the Evidence for Prioritizing Well-Being Overweight Loss. Journal of Obesity, 2014, e983495.