“You look great, have you lost weight?"
The desire for weight loss and to be a certain size may appear harmless on the surface. However, this long standing focus on weight has allowed it to become the last socially acceptable form of discrimination. Many are unaware that it is more prevalent than discrimination due to ethnicity, sexual orientation and physical disability (Puhl et al, 2008). In an effort to change the dialogue about weight and improve health outcomes, a multi-disciplinary working group spanning across VCH, revised a discussion paper titled"The Focus is on Health, Not Weight".
The hope is to eliminate experiences like those of Ellen Bennet, a Victoria woman who died of cancer in 2018. Her obituary states:
“A final message Ellen wanted to share was about the fat shaming she endured from the medical profession. Over the past few years of feeling unwell, she sought out medical intervention and no one offered any support or suggestions beyond weight loss. Ellen's dying wish was that women of size make her death matter by advocating strongly for their health and not accepting that fat is the only relevant health issue."
What underlies Ellen's experience is weight bias and stigma. Weight bias is negative weight-related attitudes and beliefs that manifest as negative stereotypes (e.g. lazy, unintelligent or lacking will-power), social rejection and prejudice. Weight bias and stigma are often ignored and unchallenged. Unfortunately, weight bias is prevalent across most health professionals and students, including doctors, nurses, dietitians and mental health professionals (Puhl and Heuer, 2009).
Recommending weight loss doesn't work long term. Most people regain the weight plus more than what they started with (Mann et al, 2007). Individuals who try to maintain weight loss can become overly preoccupied with food, weight and eating, often restricting food and/or binging. Those who diet display disordered eating behaviours and are at risk for developing clinical diagnosable eating disorders.
Ending dieting behaviours is crucial to treat eating disorders. As health professionals, we have an obligation to contribute to the health of patients and do no harm. However, encouraging individuals to pursue weight loss and dieting causes a dilemma. It is not only harmful, but unethical (Hawks and Gast, 2007). A question to consider is: Would you provide the same recommendation to someone who is 'slim?'
A working group consisting of representatives from Medical Health Officer, Mental Health, VCH Public Health Dietitians, VCH Eating Disorder Program, and Vancouver Acute, revised a discussion paper titled “Focus on Health, Not Weight". This document is meant to inform the practice of health professionals and consider a weight-inclusive approach as an alternative to a weight-centric approach.
As Eating Disorder Awareness Week (EDAW) launched on February 1 across the country, we have an opportunity to raise awareness that weight stigma is a large contributing factor. A review of nearly fifty years of research confirms that anorexia nervosa has the highest mortality rate of any mental disorder (Arcelus et al, 2011). Reducing weight stigma not only decreases pressure on higher weight individuals to suppress their weigh, but also reduces the risk of eating disorders.
Consider weight stigma training with co-workers online and incorporating weight stigma training for all new program staff. View free online presentation by former VCH dietitian Gerry Kasten about weight bias here and journal article here.
Consult discussion paper The Focus is on Health, not Weight for strategies to support professional practice across all programs and disciplines. Consider reviewing policies, procedures and practices that focus on weight and weight loss.
Consider how we talk about other people's bodies, food and weight, especially in the workplace, such as “You look great, have you lost weight?" These comments often go unnoticed because they are socially acceptable, yet they contribute to weight stigma.
There will likely be people who disagree with this point of view. For many health professionals a weight-focused perspective was the 'norm,' reinforced through training. The topic of weight bias is uncomfortable but only through ongoing discussion can it become more recognized as an issue to address. Over time, if we work to support each other around this challenging topic, we can reduce harm, appreciate that bodies naturally come in a variety of shapes and sizes, and ensure optimal health and well-being are provided to everyone, regardless of their weight.
This article is written by Focus on Health not Weight paper working group members: Kylah Blair, VCH Eating Disorders Program Clinical Supervisor and Vanessa Lam, RD, VCH Public Health Dietitian.