The term “weight neutrality” has become more frequently used and, consequently, more misunderstood. Some people claim that weight neutrality is equivalent to laziness and that weight-neutral medical providers are “promoting obesity”. But as a weight-neutral dietitian, I can tell you that this is not the case.

If you’re new here, hello and welcome! My name is Hannah and I am a non-diet dietitian here to help you improve your relationship with your food and exercise through a weight-neutral approach.

Before we proceed, I want to acknowledge my thin privilege. Although I have worked closely with hundreds of people in larger bodies, I have limited personal experience with fatphobia from medical providers, family members, or strangers. I too am a victim of diet culture and have felt the pressure to lose weight, but never from the perspective of someone who is experiencing weight stigma. While I am a HAES-aligned dietitian, I recommend learning more about HAES and fat activism from others in larger bodies. I have a list of some of my favorite fat activists in this post.

What is weight neutrality?

Weight neutrality, a term sometimes used interchangeably with weight inclusivity, is an approach to healthcare that leaves behind the use of bodyweight and body mass index (BMI) as sole determinants of health. Instead, weight neutrality involves assessing wellbeing beyond the number on the scale.

Weight neutral medical providers, including dietitians, encourage their patients to focus on making health-promoting changes that may or may not result in weight changes. These health changes may include energy levels, sleep quality, mental health, and various biomarkers and lab values, such as blood pressure and cholesterol levels.

Weight neutrality does not mean that body weight is never discussed or considered. In fact, weight history, body composition, and unusual weight fluctuations may be investigated in weight-neutral care. The difference is that weight is not the only topic of discussion or measurement of progress.

The risks of weight-centric healthcare

Traditional healthcare models tend to be weight-centric, which involves using bodyweight as an unequivocal marker of health status. But health is complex and dynamic and the number on the scale does not paint the full picture.

Weight-centric medical providers often prescribe weight loss as a solution to various health concerns. In many cases, weight loss will even be encouraged even if the patient is otherwise healthy. But the truth is that weight loss is not always a sign of improved health and weight gain is not always a sign of worsened health. In fact, being “underweight” has a higher mortality risk than being “overweight” or “obese”. Being at a lower weight has been linked to issues such as weakened bones, fertility issues, and poor healing and recovery from illness. In short: thinner is not equivalent to healthier.

Contrary to popular belief, there is never a good reason for a medical professional to prescribe weight loss. We don’t have any evidence that weight loss alone improves a person’s health or lowers their risk of disease. And even if we did, there are not any known weight loss approaches that come without risk.

Now, this does not mean that weight loss is inherently “bad” or “unhealthy”, just as weight gain is not inherently “bad” or “unhealthy”. Some individuals do lose weight when they stop dieting, especially if they were previously binge eating, emotionally eating, or in any other fashion eating more than what their body needs.

the risks of weight centric healthcare dietitian hannah

Diets don’t work

Intentional weight loss is not only physically and mentally difficult, but also nearly impossible to maintain in the long term. In fact, 95-98% of dieters regain weight that is lost (and then some). And this is not an issue of willpower! No matter how committed someone is to attaining a lower weight, we cannot outsmart our biology.

Our bodies do not know the difference between a diet and a famine. So when we start to restrict in the name of weight loss, our body kicks its compensatory mechanisms into place. When you go on a diet, you may notice that food seems even more appealing. Your cravings go through the roof, you feel like you never experience fullness, and you can’t stop thinking about when your next meal will be. This is because the body experiences hormonal and psychological responses to restrictive diets.

Weight loss is also not as simple as just eating fewer calories. Sure, this is what it boils down to. But factors such as genetics and the social determinants of health will also impact someone’s “success” in dieting.

Disordered eating behaviors

Weight-centric healthcare may increase the prevalence of disordered eating and the risk of eating disorder development. Dieting (any pursuit of weight loss through food restriction) is the largest predictor of eating disorders. Unfortunately, I have worked with countless eating disorder patients that have been told by their doctors to lose weight. It is so easy for the recommendation to lose weight to turn into an all-consuming obsession.

Putting patients on diets can lead to poor body image and body dysmorphia, a worsened relationship with food and exercise, and mistrust of hunger and fullness cues.

Related post: Reject the Diet Mentality

Weight stigma

You know what may be worse for your health than being “overweight”? The fatphobia that you undoubtedly experience if you are “overweight”.

Weight stigma is internalized negative attitudes and discriminatory acts targeted towards individuals because of their size, shape, or weight. Examples of weight stigma include:

Receiving negative comments about your weight, including from healthcare professionals.
Poor treatment by coworkers or bosses because of your size or shape.
Higher insurance premiums because of weight.
Being required to lose weight for a medical procedure, such as a joint replacement, organ transplant, or infertility treatment.

Studies show that weight stigma increases the risk of high blood pressure, metabolic syndrome, diabetes, high cholesterol, and eating disorders. There is compounded stigma that exists for those in marginalized groups who are also stigmatized for disability, race, gender, age, and sexual identity.

Most of the differences we see in health outcomes between thin and fat people likely has more to do with weight stigma than weight itself. People with higher bodyweights tend to avoid going to the doctor because they are shamed for their weight and conditions may be dismissed due to their body size. I have heard countless stories from patients, clients, and people in my DMs that state they have gone to their primary care provider for something like a sore throat and left with a handout on what diet they should go on.

Those in larger bodies also experience a myriad of extra stressors that those who are thinner may not such as finding clothes that fit, being on the receiving end of fat jokes, and anxiety about fitting comfortably into a chair when they go out to eat or when on an airplane.

The benefits of a weight neutral approach

The main concept of weight-neutral care is that health is not defined by weight and people of all body sizes receive the same level of care and medical attention. This does not mean that weight is claimed to have no impact on mental or physical health. Rather, a weight neutral approach involves looking at the bigger picture instead of focusing on one piece of data.

Weight-neutral care has been linked to improvements in:

Health behaviors (increased movement and nutritious food choices)
Blood pressure
Cholesterol levels
Self-esteem and mood
Body image
Weight stability
Eating behaviors (decreased disordered eating)
Engagement levels (lower dropout rates)

Strategies to embrace weight neutrality

So, you’re on board with the weight-neutral approach, but how exactly do you put it into practice?

First of all, I need to note that your health is not a moral obligation. While it is of course okay to try and make health improvements, it is also okay if you aren’t always “self-helping” yourself. It’s okay to just be.

If you are interested in finding a weight-neutral provider (including doctors, therapists, personal trainers, and dietitians), you can search the Health at Every Size Healthcare Provider Listing.

Ditch the scale

Try to forget about pursuing weight loss. Yes, I’m serious. I do acknowledge that this is far easier said than done, especially if you have been considered “overweight” or “obese” for your entire life and constantly told that your body is a problem. But weighing yourself and obsessing over the number is only holding you back. And as a reminder, the number on the scale hardly tells us anything about what is actually going on in our body.

Focus on behaviors rather than weight

It is much more worthwhile to direct our efforts towards behavior changes that we have more control over (reminder: weight is not a behavior). For example, someone in a larger body with type 2 diabetes may be encouraged to lose weight under a weight-centric care model. But there is no guarantee that weight loss will improve blood sugars. And even if this patient does lose weight and also have improvements in blood sugars, how do we know this was as a result of the weight loss and not the behavior changes that were made that happened to lead to weight loss?

In this same example, a weight-neutral approach to treating type 2 diabetes may involve considering meal and snack timing, nutrient intake, stress levels, hydration status, activity levels, sleep quality/quantity, and relationship with food. Will the patient lose weight while making changes? Maybe, maybe not. Even if they do not lose weight, this does not mean that their health could not have improved.

Diversify your social media

There are both a lot of pros and a lot of cons to social media. It allows us to find positive communities (like on my Instagram or TikTok). It can be a way to connect with family and friends, especially long distance ones

Social media can also be a platform for us to discuss topics we are passionate about. If it wasn’t for social media, I probably would not have learned about intuitive eating!

But alongside those pros there are plenty of pitfalls to social media and it can be dangerous if used incorrectly. We are constantly being exposed to messages that tell us that thin bodies are good and big bodies are bad. These images are often altered and many times are not even a realistic portrayal. If you only follow individuals that meet the narrow definition of beauty, this can greatly impact your body image and your work towards body acceptance.

Spend some time replacing the negative influences online with more positive ones. I share some accounts that I love to help you diversify your feed in this post.

what is weight neutrality dietitian hannah

What if I still want to lose weight?

We have been conditioned to believe that being thinner is better, so it is okay if you have the desire to lose weight, even after reading this post. This desire to be smaller won’t go away over night. Body image work is hard and it goes far beyond the concept of “just love yourself”.

Here are a few questions you can ask yourself to start unpacking the belief of the thin ideal:

What are you beliefs about weight and body size? Where did you learn these beliefs?
Has pursuing weight loss ever worked for you long-term?
How has pursuing weight loss made you feel? Is there anything you had to compromise to reach your “goal” weight? What physical and emotional harm did you experience while dieting?
What did you miss out on while dieting and pursuing weight loss?
Who is benefiting from making you feel like your body does not deserve love unless its smaller? Who profits from telling you that you need to change?

Bottom line

Weight neutrality and the non-diet paradigm is an accepting, evidence-based, nourishing, and balanced approach to health. Contrary to popular belief, abandoning the weight-centric approach is not synonymous to “promoting obesity”. Anti-diet is not the same as anti-health. It is possible to pursue health changes without worrying about the number on the scale.

What did you think of this post? Leave a comment below.

More HAES and weight-neutral resources: https://haeshealthsheets.com/resources/

Disclaimer: this post is for informational and educational purposes only and is not a substitute for professional medical advice.