The weight-inclusive versus weight-normative approach to health: evaluating the evidence for prioritizing well-being over weight loss.

Tracy L Tylka,Rachel M Calogero,Rachel A Annunziato,Deb Burgard,Ellen Shuman,Sigrún Daníelsdóttir,Chad Davis

doi:10.1155/2014/983495

Abstract

Using an ethical lens, this review evaluates two methods of working within patient care and public health: the weight-normative approach (emphasis on weight and weight loss when defining health and well-being) and the weight-inclusive approach (emphasis on viewing health and well-being as multifaceted while directing efforts toward improving health access and reducing weight stigma). Data reveal that the weight-normative approach is not effective for most people because of high rates of weight regain and cycling from weight loss interventions, which are linked to adverse health and well-being. Its predominant focus on weight may also foster stigma in health care and society, and data show that weight stigma is also linked to adverse health and well-being. In contrast, data support a weight-inclusive approach, which is included in models such as Health at Every Size for improving physical (e.g., blood pressure), behavioral (e.g., binge eating), and psychological (e.g., depression) indices, as well as acceptability of public health messages. Therefore, the weight-inclusive approach upholds nonmaleficience and beneficience, whereas the weight-normative approach does not. We offer a theoretical framework that organizes the research included in this review and discuss how it can guide research efforts and help health professionals intervene with their patients and community.

Highlights

Jasmine is waiting in the exam room and her chart shows that her weight today is up five pounds from her last visit two years ago, putting her body mass index (BMI) at 32
For the purposes of this paper, we explore one version in more depth, the Health at Every Size (HAES) model, as trademarked and defined by the Association for Size Diversity and Health (ASDAH) [54]
Dr Johnson says, “You know, Jasmine, I have been reading the research on weight loss interventions and weightcycling and I’m realizing that if the same thing happens to almost everyone, it probably is not the fault of the person, it is probably more about the process itself

Summary

Introduction

Jasmine is waiting in the exam room and her chart shows that her weight today is up five pounds from her last visit two years ago, putting her BMI at 32. Instead of imagining that well-being is only possible at a specific weight, a weight-inclusive approach considers empirically supported practices that enhance people’s health in patient care and public health settings regardless of where they fall on the weight spectrum [1, 2, 22]. These approaches differ in the emphasis each one places on weight. We review the problems and limitations of the weight-normative approach to health and highlight the weight-inclusive approach as an alternative model for health care and health improvement

The Weight-Normative Approach

The Weight-Inclusive Approach

Summary of the Competing Approaches

Directions for Future Research

Findings

Conclusion