10 October 2011

Health at every size

Since we all know that diets don't work, we need to get ourselves out of our diet mentality and be more relaxed around food, writes registered dietician Kim Hoffmann.


Since we all know that diets don't work, we need to get ourselves out of our diet mentality and be more relaxed around food, writes registered dietician Kim Hoffmann. 

The overweight and obesity problem across the world is a major concern. The South African statistics are dismal – according to the Medical Research Council's Chronic Diseases of Lifestyle report, the overall prevalence of overweight and obesity in South Africa is "high", with more than 29% of men and 56% of women classified as overweight or obese. 

This is despite a large level of body dissatisfaction leading to repeated attempts to lose weight, numerous programmes aimed at patient education, and the private weight loss industry. Most individuals who attempt to lose weight are unable to keep their weight off over the long term, and do not get the benefits of improved morbidity and morality. 

The concern is that this "weight focused" idea is not only ineffective at producing thinner, healthier bodies, but is also damaging us. It is contributing to food and body preoccupation, repeated cycles of weight loss and regain, distraction from other personal health goals and wider health benefits, reduced self-esteem, increased disordered eating as well as eating disorders per se, a general decrease in health, and weight stigmatisation and discrimination.  

Weight cycling

Trying to lose weight typically results in weight cycling, and it is in fact weight cycling that results in increased risk for many obesity-associated diseases such as hypertension, insulin resistance and dyslipidemia (high levels of cholesterol or triglycerides in the blood) due to the fact that it causes increased inflammation in our bodies. It may therefore be that the association between weight and health risk exists because of weight cycling rather than being overweight.

Studies have also shown that most health indicators (for example blood pressure, blood lipids, insulin sensitivity) can be improved through changing health behaviours (for example by increasing aerobic exercise), regardless of whether weight is lost.  

Health at Every Size: shifting the paradigm from weight to health

A growing trans-disciplinary movement called Health at Every Size (HAES) shifts the focus from weight management to health promotion. The main aim of HAES is to support improved health behaviours for people of all sizes without using weight loss as a goal; weight loss may or may not be a side effect.

The main focuses of HAES include:

Encouraging body acceptance as opposed to weight loss or weight maintenance

The evidence suggests that promoting body discontent results in less favourable lifestyle choices. The compassion-focused behaviour change theory suggests that self-acceptance is a cornerstone of self-care, meaning that people with strong self-esteem are more likely to adopt positive health behaviours.  By learning to value their bodies as they are right now, even when this differs from a desired weight or shape or generates ambivalent feelings, people strengthen their ability to take care of themselves and sustain improvements in health behaviours. 

Supporting reliance on internal regulatory processes, such as hunger and satiety, as opposed to encouraging cognitively-imposed dietary restriction

Conventional recommendations view conscious efforts to monitor and restrict food choices as a necessary aspect of eating for health or weight control.  HAES teaches people to rely on internal regulation, (also known as intuitive eating), which encourages them to increase their awareness of their body’s response to food and learn how to make food choices that reflect this "body knowledge". 

Food is valued for nutritional, psychological, sensual, cultural and other reasons.  HAES teaches people to make the connections between what they eat and how they feel in the short- and medium-term, paying attention to food and mood, concentration, energy levels, fullness, ease of bowel movements, comfort eating, appetite, satiety, hunger and pleasure as guiding principles. 

Learning intuitive eating is a journey that takes time.  Especially if you have a long history of dieting, other self-imposed dietary restriction or body image concerns.  You may feel very insecure letting go of old habits and attitudes, but eating intuitively happens gradually as old beliefs about food, nutrition and eating are challenged, unlearned and replaced with new ones.  There is significant evidence that intuitive eating skills can be learned.

Supporting active embodiment as opposed to encouraging structured exercise

HAES encourages people to build activity into their day-to-day routines and focuses on helping people find enjoyable ways of being active. The goal is to promote well-being and self-care.  Active living is promoted for a variety of physical, psychological and other accompanying benefits which are independent of weight loss.

Since we all know that diets don’t work, we need to get ourselves out of our diet mentality and be more relaxed around food.  Get into some good habits and focus off of that number and you will see that it is a lot easier than you had imagined.

Information take from "Weight Science: Evaluating the Evidence for a Paradigm Shift" an article written by Linda Bacon and Lucy Aphramor and published in the Nutrition Journal 2011, 10 (9).

Written by registered dietician, Kim Hoffmann, of The Lean Aubergine Dietetic Services. To sign up for the monthly Lean Aubergine newsletter send an email to or

- (Health24, September 2011)

Read more:

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Food diaries are the way to go
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