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Why I won’t prescribe weight loss

 

Josephine Money, APD

Josephine is an Accredited Practicing Dietitian, an Accredited Nutritionist and director of Eat Love Live. She has a client-centred approach providing individual nutrition counselling; with over 10 years’ experience in private practice. Josephine has experience across a diverse range of settings including community and public health and in variety of modes including working with individuals, groups and program development.

 

 

I am a dietitian and I won’t prescribe weight loss

Surprised? Many people are. My team and I do not prescribe to the stereotype of dietitians.

Yes, we are qualified dietitians with a wealth of experience between us, clinical hospitals, Sports, pediatrics.

We believe that weight is a non-modifiable risk factor for health and that focusing on this with clients can cause harm. For example, someone who lives in a higher weight body has experienced harm from interpersonal and systemic weight stigma their whole life. The ongoing trauma from this is having a much greater impact on their physical and emotional health then food ever will. We are trauma informed, social justice aware and passionate.

 

Why I don’t focus on 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 improved by focusing on (9-14):

  • Including fruit and vegetables (regardless of other foods consumed) and food variety.
  • Activity
  • Smoking
  • 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 wellbeing.

 

So, what can we do then?

Provide nutritional interventions to improve health that are based on evidence, and a space to reflect and unpack as food and eating is so much more complicated than we assume. The relationship we all have with food and our bodies have been influenced by the systemic and individual beliefs of the diet culture we all exist in.

Support people 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.

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.

Help them to understand the multifaceted 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.

Help people understand what are normal and expected changes in body shape and size through the lifespan.

Explore ambivalence and help to move them forward to a place of change.

Focus on evidence supported interventions to improve blood pressure, BGL, Cholesterol, sleep, energy, and feelings of wellbeing.

 

This approach is not anti-weight loss

  • It is anti the diet culture and systemic structures that make people feel like their body needs to fit a particular mold to prove their worth.
  • It is anti short-term interventions that fail and leave people feeling worse.
  • It is anti creating further shame and harm for people who have experienced weight stigma.
  • It is 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 accurate information.

 

To learn how to support your patients to navigate this sensitive issue join Josephine Money for our upcoming on-demand webinar The Spectrum of Eating: What’s Healthy Eating and When to be Worried? These webinars are free for ACNEM members, and this one will be released on 25th August at 7pm.

 

  1. 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.
  2. 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
  3. 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.
  4. 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.
  5. 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.
  6. 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
  7. 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
  8. 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.
  9. 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.
  10. 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
  11. 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.
  12. 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.
  13. 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