More and more you are likely to hear people speaking out against weight biased care, and calling out fat phobia for the harm it is doing to everyone, particularly to those living in bigger bodies. But what are the alternatives? Thankfully, there are superheroes across the world working hard to change the medicalisation of size, and the moral value given to smaller bodies.

Change isn’t easy, and those working towards change are often having to adapt, rethink, and re-language their position as they continue to learn things they didn’t know before. If you’re already familiar with Health At Every Size® (HAES), Non-Diet approaches, and now Size Inclusive spaces and care – you’d know the language, and the meaning, is constantly evolving. The premise however remains the same – safe and equitable healthcare for all people in all bodies.

A size inclusive approach is accepting and respecting of the inherent diversity of body shapes and sizes (1). It does not stigmatise specific weights, nor does it automatically attribute health difficulties to the size of one's body. Rather, HAES practitioners work from a position of respect for all people and all bodies. They understand there are various determinants of body weight and a major one is genetics. That’s right – your family’s gene pool has much more influence over your body weight than the food you eat or the amount of exercise you engage in. (3)

Health At Every Size®, Non-Diet and Size Inclusive care also holds the positions that pathologising specific weights or focusing on weight as a modifiable outcome, is not endorsed. Research has shown that long-term weight loss is unachievable and more often results in regaining the weight or further weight gain. (2) Not the mention the host of health risks that dieting and restrictive eating create!

Engaging in repeated dieting behaviours or restrictive eating patterns is the number one behavioural risk factor for developing an eating disorder and/or disordered eating. Eating disorders are a serious mental health condition and impact one’s quality of life, social connectedness and physical health. (4)

Size inclusive care supports behaviours that can promote improved health that is meaningful for the individual, and works for their lifestyle, budget and culture, without focusing on weight loss. Healthcare professionals who work in this area aim to promote sustainable behaviour change that is health-promoting. (1)

This approach takes into consideration the Social Determinants of Health model which can be cited from the World Health Organisation. (5)

As you can see from Figure 1, there are many factors which come into play when we consider health. Working in a manner that respects diversity and individual agency takes into account the reality of these factors, and listens deeply to what matters for the person sitting in front of them. They will not shame you for having had a weight loss goal, however they will gently help you understand the harm that the pursuit of smaller has caused you and the people around you. From there, they will support you to define what health truly means for you.

Behaviours that focus on health without the emphasis on weight include:

- Incorporating a wide variety of foods on a regular basis

- Moving your body in ways that you enjoy and make you feel good

- Socialising with your loved ones and maintaining good quality relationships

- Getting good quality sleep

- Taking your medications as prescribed

- Finding a doctor you trust and seeing them when you need to

We understand that losing the idea of weight loss doesn’t happen overnight. In a world that is constantly telling us to be smaller, fighting it is extremely hard. Here at Person Centred Psychology & Allied Health, we take an individualised approach and develop strategies that can support your well-being, in your own way.

If you’re interested to learn more, call us to book your first appointment.

Author: Naina Varma

Accredited Practising Dietitian & Credentialed Eating Disorder Clinician

References:

1) Size Inclusive Health https://www.sizeinclusivehealth.org.au/What-is-HAES

2) Tylka, T. L., et al. (2014). "The Weight-Inclusive versus Weight-Normative Approach to Health: Evaluating the Evidence for Prioritizing Well-Being over Weight Loss." Journal of Obesity 2014: 983495.

3) Müller MJ, Bosy-Westphal A, Heymsfield SB. Is there evidence for a set point that regulates human body weight? F1000 Med Rep. 2010 Aug 9;2:59. doi: 10.3410/M2-59. PMID: 21173874; PMCID: PMC2990627.

4) Miskovic-Wheatley, J., Bryant, E., Ong, S.H. et al. Eating disorder outcomes: findings from a rapid review of over a decade of research. J Eat Disorders 11, 85 (2023).

5) World Health Organisation (WHO). (1946). Constiution of the World Health Organisation. Basic Documents, Geneva. World Health Organisation.

What Is Size-Inclusive Care and Why Do We Practice It Here at Person Centred Psychology & Allied Health?