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Weight Loss and Food Equity: Lessons from the Health at Every Size Movement…and Oprah

Health At Every Size Georgia Billboard response campaign Health At Every Size Georgia Billboard response campaign The images in the post come from the I Stand Against Weight Bullying campaign. For more information, see http://healthateverysizeblog.org/tag/georgia-billboards/ and http://istandagainstweightbullying.tumblr.com/ . Thanks to Pamela Presser, Karen Sosnoski
Ah, March...the time when the New Year’s resolution rubber hits the road.  Meanwhile, CNN Money has already predicted that the splashy New Year’s campaign featuring Oprah’s “weight-loss journey”i “may not save Weight Watchers after all.”v

Why do so many people vow to get back on the dieting treadmill—or encourage others to do so? We’ve all seen the soap-company campaign to promote acceptance of a range of body types for women (though as some have pointed out, that range is, well, still rather narrow). Yet we still live in a society that believes you can (almost) never be too thin. And that slenderness, if it isn’t health itself, sits right next to it. But is weight loss really a safe, effective, or ethical way to promote health? And what are the implications for food equity? If we consider food access a fundamental element of an equitable society, what role should issues of body weight play?

For all these reasons, those of us who want to promote health in the context of food equity work would do well to consider some lessons from the Health at Every Size (HAES) framework. HAES originated in the Fat Acceptance movement, eventually drawing the attention of nutritionists, dietitians, and others in health promotion-related fields or working to end various forms of discrimination. The increasingly influential paradigm of HAES promotes health without focusing on weight—an approach that has much to offer from an equity perspective, with significant advantages for advancing health and enhancing a sense of well-being as well.

To improve key health indicators such as blood pressure and blood sugar levels, we need to be physically active and eat well. The best way to promote health in relation to food and eating is to enable these practices. In a food equity context, this means enhancing our efforts to 1) increase fresh food access, and 2) provide support for reasonably convenient, culturally appropriate ways of cooking and eating that maximize flavor and nutrition while decreasing reliance on highly processed food products.

Most importantly, emphasizing well-prepared fresh foods, especially vegetables and fruits, and being physically active are the only methods known to be truly safe and effective for improving diet-related health measures.

Safety: Being active and emphasizing fresh food carry no inherent risks. The health risks of dieting, on the other hand, are well-known yet curiously seldom heeded. It is fairly typical for dieters to lose weight, regain it, and repeat the cycle. This pattern undermines cardiac health and is associated with negative blood sugar and blood pressure outcomes. The physiological sense of deprivation entailed by the significant calorie restriction necessary for weight loss also alters the sense of satiety, undermining our ability to know when we’ve eaten enough. These effects can persist over time.

Effectiveness: Compelling evidence indicates that, while some dieters—a distinct minority—do lose weight and keep it off, most do not. Yet the majority of people who concentrate on eating well and being active instead of attempting to lose weight will see marked improvements in health, regardless of whether they reach a specified weight target. Indeed, these are exactly the practices that everyone needs to follow. Basing them on weight status gives some a false sense of security while inappropriately singling out others.

Physical activity and eating well not only improve specific health measures, they can greatly enhance our own sense of felt health and well-being. We can focus on how eating fresh food makes us feel, in terms of pleasure and satisfaction, energy, mood, digestion, how well we sleep. Weight-loss dieting encourages a preoccupation with calories, grams of sugar or fat, or pounds on the scale that makes it easy to lose touch with the multi-faceted dimensions of our own well-being.

Of course, it takes time to form new habits and adjust to new ways of eating, but a HAES approach can facilitate this process by keeping the focus on health—including how we feel—instead of being so preoccupied with weight that we believe we’ve failed when the pounds don’t drop as quickly as desired, or at all, or don’t stay off. In fact, when weight loss is framed as necessary and important, these feelings of failure and even shame are likely to occur even though specific health measures may be improving. These feelings can lead dieters to give up on being more active or increasing fruit and vegetable consumption.

The case for HAES is even stronger when we consider issues of equity. The focus on weight stigmatizes everyone considered overweight or obese. Ubiquitous weight-loss products, regimens, and media exploit the very fact that weight loss is so difficult, and, if attained, usually impermanent. This vast and highly profitable industry only reinforces the false notion that anyone can lose weight if they just try hard enough (and buy the right stuff).iii So, if you don’t succeed, you obviously haven’t tried hard enough—a failure of character. This stigma all too often translates into social prejudice, shaming, bullying, institutional discrimination, and even violence, pervasive cultural forces which become even more harmful when internalized. And it’s extremely difficult not to internalize those values.

The equity implications of weight-related stigma are even more serious given the associations of race, ethnicity, impoverishment, and immigrant status (especially Latin or African) with being considered overweight or obese. People of color, poor people, and recent immigrants already experience an array of differential obstacles and challenges affecting their prospects in all kinds of ways, including food deserts and multiple barriers to physical activity. It’s as unjust as it is unnecessary to compound these challenges with weight-based stigma.iv

Returning to the world’s most prominent dieter, Oprah, one of her many gifts is the Everywoman quality that makes her so beloved. She may be wealthy beyond dreams, yet she still seems so “normal,” so human. Her struggles with weight may be part of this; we all know how very normal it is weight-loss diets not to “work.” As Caissie St.Onge observes:
Oprah is arguably the most accomplished, admired, able person in the world. She creates magic for herself and other people on the regular. So, if Oprah can’t do permanent lifelong weight loss, maybe it can’t be done. Oprah is also crazy rich. If Oprah can’t buy permanent lifelong weight loss, maybe it can’t be bought. And that sucks. But it is also incredibly freeing if you, like me, have thought about your weight so many times throughout every day of your life that it becomes as maddening and distracting as if you’d stowed a tell-tale beating heart beneath your floorboards.v

If we can’t buy weight loss nor achieve it on our own, maybe we need a public health approach that respects health and well-being as connected goals. One that puts forward a weight-neutral view of health and shows how this is in everyone’s interest. One that eliminates barriers to healthful practices while respecting the rights of individuals to control their own bodies and make their own decisions. HAES, predicated on nondiscriminatory health promotion, has much to offer as a food equity tool.

Jose Andres Sustainable Plate UP 2016 WLA 2866 1090
Abby Wilkerson (far right) is the author of Diagnosis: Difference: The Moral Authority of Medicine (1995) and The Thin Contract: Social Justice and the Political Rhetoric of Obesity (forthcoming). She coedited a special issue of GLQ: A Journal of Lesbian and Gay Studies, “Desiring Disability: Queer Theory Meets Disability Studies” (2003) with Robert McRuer. She has also published a number of articles in journals and anthologies, teaches in the University Writing Program at George Washington University, and is an active member of the Prince George's County Food Equity Council.

i. “Oprah Winfrey’s Weight-Loss Journey,” https://www.youtube.com/watch?v=eNU-pvyhQd4

ii. Paul R. LaMonica, “Oprah may not save Weight Watchers after all,” http://money.cnn.com/2016/01/11/investing/weight-watchers-oprah-winfrey/

iii. They also contribute to the misconception that the healthfulness of a food is what it doesn’t contain (fat, sugar, carbs, sodium, calories...) rather than what it does contain (actual nutrients, its own inherent natural flavor). Not to mention that many deprivation-style frozen meals and other highly processed weight-loss “food” products directly undermine our health and nutrition rather than promoting it...yet do so in the name of health.

iv. Some of my own research traces how characterizations of African-Americans and Latinos as overweight and obese are used to justify white supremacist and anti-immigrant discourses.

v. Cassie St. Onge,“I’ve spent years trying to get skinny. Oprah’s Weight Watchers ads convinced me to stop,”Vox, Feb. 15, 2016, http://www.vox.com/2016/2/15/10980830/oprah-winfrey-weight-watchers
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