Healthy Living in the North

Helping or Harming:  Reflections from 20 years of being a Dietitian

A crowd of people attends a farmers' market

“Healthy” comes in all shapes and sizes.

Oh, the conviction of youth!  Long gone are the unshakable beliefs from my dietetic internship about how to define “healthy” and the importance of weight in preventing disease. Twenty years have passed and, in that time, I’ve worked in five different provinces with a variety of patients and partner organizations. For instance, young families; schools; clients living with diabetes, heart disease, cancer, and disordered eating; and seniors in care homes, all of whom came from very diverse backgrounds.  In nearly every case, health was defined, in part, by weight. Today, I question that belief. Why? Because I’ve seen so many instances where a subtle emphasis on weight has contributed to some harm.

I’ve learned that while weight is often one of the first lines of treatment when someone is diagnosed with a chronic disease, research tells us that less than one percent of people successfully keep weight off after four years, and usually regain the lost weight plus some. In the end, after treatment, people are at a higher weight and often feel bad about themselves. This can’t be good for health.  Does it make sense to promote a treatment that is doomed to fail?

The recommendation to lose weight perpetuates something called the “thin ideal” (believing that a slim body is the standard for beauty and health), which is based on an assumption that people defined as “overweight” (as per the problematic standard of BMI or body mass index) eat poorly, too often, and do not move enough. My twenty years of experience tell me that this is not the case. Rather, healthy bodies come in all shapes and sizes and are supported by healthy and intuitive eating, active living, and positive self-esteem. Thus, a better plan is to focus on supporting everyone, no matter their size, to live well.

The “thin ideal” has normalized weight bias and stigma, where we live, work, play, and are cared for. What is weight bias and weight stigma?

  • Weight bias is a negative judgement of someone because of their weight, shape and/or size.
  • Weight stigma is what a person experiences when weight bias happens to them.

Weight bias and stigma can seem harmless and might even be done in the spirit of helpfulness, but it still hurts. Examples of weight stigma include:

  • Refusing to offer dessert to someone and/or questioning whether someone “needs” that serving of dessert because of their size.
  • Using headless images of “overweight” people or images of “overweight” people being sedentary in handouts and presentations.
  • Using the word “fat” as an insult instead of what it is, which is a physical description of body composition.
  • Assuming someone is unhealthy if “overweight” or healthy if “underweight” or “normal weight.”
  • Failing to offer healthy food at school because “we don’t have fat kids at our school” (yes, one school actually gave this as a reason why they didn’t need to follow the Guidelines for the Sale of Food and Beverages in BC Schools!).

Weight bias needs to stop.  It starts with us thinking about what our own biases and assumptions about weight might be (take the Weight Implicit Attitudes Test) and developing respect and empathy for people who are impacted by weight bias. Last week was Weight Stigma Awareness Week, but it’s an issue that we need to be aware of all year round. Learn more here.

Flo Sheppard

About Flo Sheppard

Flo has worked in northern BC for over 20 years in a variety of roles. Currently, she is the Chief Population Health Dietitian and Team Lead for the Population Health Nutrition Team. She takes a realistic, supportive, and non-judgemental approach to healthy eating in recognition that there are many things that influence how we care for ourselves. In her spare time, you are likely to find Flo cooking, reading, volunteering, or enjoying the outdoors.

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