Journal of Obesity / 2014 / Article / Tab 1

Review Article

The Weight-Inclusive versus Weight-Normative Approach to Health: Evaluating the Evidence for Prioritizing Well-Being over Weight Loss

Table 1

Translating weight-inclusive principles into weight-inclusive practice.

Weight-inclusive principleWeight-inclusive practice

(1) Eradicate weight stigmaConduct trainings to inform other health care professionals about the weight-inclusive approach. Ensure medical offices have medical supplies and accommodations for all patients across the weight spectrum. Talk with patients’ families, friends, and partners about the types of comments that are stigmatizing and negatively impacting the health of their loved ones. Promote the weight-inclusive approach and strategies for following it.
All health care professionals.

(2) Target internalized weight stigmaHelp patients reduce placing blame on their bodies (and others’ bodies). Challenge adoption of societal appearance ideals. Consider conducting cognitive dissonance interventions (e.g., [134]) to lessen adherence to unrealistic appearance ideals.
Mental health professionals

(3) Target body shameHelp lessen patients’ embarrassment, hatred, and dissatisfaction toward their bodies by helping them define “beauty” more broadly and to appreciate their bodies. Cognitive dissonance interventions may help increase body appreciation.
Mental health professionals

(4) Redirect focus from external critique of weight and size to a “partnership” with the bodyDirect attention to what is happening within their bodies rather than “picking apart” their appearance (e.g., lumps, appearance of moles, lack of energy, shortness of breath, etc.). This partnership with their bodies may help detect and prevent the progression of disease.

(5) Look for signs of diminished well-beingPresent options to alleviate distress and heighten life satisfaction; options should not be limited to medication. Know mental health professionals who follow a weight-inclusive approach in the community and refer patients as needed.

(6) Look for signs of disordered, emotional, and/or binge eating Rather than BMI, explore each patient’s weight trajectory across time to detect unusual gains and losses that could be reflective of disordered eating.
Do not praise weight loss.
Do not immediately address weight gain with weight loss recommendations.
Explore with patients whether there is a connection between disordered eating patterns and emotional regulation. For instance, if they report bingeing behaviors, ask about how they felt at the time and contextual factors. If there is a connection, distress tolerance and mindfulness interventions (e.g., Acceptance and Commitment Therapy) may be helpful.
Mental health professionals

(7) Respond to requests for weight loss advice with a holistic approachRespond (when asked by patients for advice or help with weight loss) with a holistic approach to health via encompassing and encouraging emotional, physical, nutritional, social, and spiritual health, rather than a weight-focus.
Physicians, nutritionists

(8) Sustain health promoting practicesIdentify and facilitate access to healthy sustainable behaviors for patients.
All health care professionals

(9) Reconnect with food and internal cuesHelp patients (a) abandon dichotomous thinking about foods as “good” and “bad” and the morality surrounding food restriction, (b) relearn how to recognize and respond to their hunger and satiety cues, and (c) determine how certain foods affect their bodies.

Health care professionals who may want to take the lead in implementing this principle within their practice. We encourage a team approach whereby physicians, mental health professionals, and nutritionists work together to ensure that a weight-inclusive approach is followed.

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