Healthy at every size: Understanding size diversity
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The problem of what to do about rising obesity rates has been a major concern since the early 21st century, as the number of overweight people in the world was found to equal the number of underfed people.
Obesity has also been linked with a range of chronic diseases including Type 2 diabetes, hypertension, several cancers, gall bladder disease, coronary artery disease, and stroke.
As a result, reducing obesity rates is a target for public health action, and existing approaches to obesity management and prevention remain under intense scrutiny.
With the pandemic wrecking havoc around the world, obesity, health and the appearance of health has been topical. What does health look like? Many health conscious people argue that people deserve an environment and culture that supports their health, regardless of their size.
One of the health myths is a narrow definition of what health means and what contributes to health.
“There are many ways to measure health; weight is just a marker of size,” notes Lindo Bacon, a professor and researcher at the University of California at Davis and author of the book Health at Every Size.
“If you care about health, why not look at direct markers of whatever health attribute you are interested in, however you define health? Why go at it indirectly?” For example, someone’s size can’t tell us if they are developing Type 2 diabetes, but their blood sugar levels can.
Health at Every Size (Haes) is a set of principles that was established in 2003 by the Association of Size Diversity and Health. It’s mission was simple – to reject the idea that weight, size, or body mass index (BMI) should be considered proxies for health.
Haes encourages health practitioners to integrate into their practice an acknowledgement of something that many experts have known for quite a while: weight can be one of many indicators of health, but it’s not the only one. It’s also the approach that has informed my own practice as a trainer and coach for the last 10 years.
The Haes approach has caused much controversy. There are shifts from a weight-focused to a health-focused paradigm which challenges some of the key assumptions of traditional approaches to weight management. Overall health does not have an appearance or size.
It is important to understand that removing the focus on weight does not mean ignoring health risks and medical problems.
To quote the Association of Size Diversity and Health: “It is a movement working to promote size-acceptance, to end weight discrimination and to lessen the cultural obsession with weight loss and thinness".
The Haes approach promotes balanced eating, life-enhancing physical activity, and respect for the diversity of body shapes and sizes.
Louise Green is a plus-size trainer, athlete, and a part of the Big Fit Girl and Fitness for Everyone team.
She says: “The principle of weight inclusivity is a fundamental reason I was finally able to embrace fitness in a sustainable way. It started with that running coach, who, for the first time in my life, trained and coached me without ever mentioning my size, the need to burn calories, or any other weight or body-related language.”
“This resonated with me deeply because she was seeing me as an athlete in the making, rather than a fat person trying to get my s*** together, which is often how it felt I was being seen.”
Green says she had a light bulb-moment: “I realised that I could live an athletic life not for the caloric expenditure but because it made me feel kick-ass, powerful, and alive.
“I could turn my energy and focus toward my athletic goals and let go of the obsessive energy around counting calories, how much I exercised, and what I could eat as a result. This freed up an enormous amount of mental real estate.”
It was also important to change habitual thinking, says Green: “When I was finally free of thinking there was something pathologically wrong with my body, I wanted everyone to know about it and experience it. This is something that I now, in turn, try to do with the people I train. I see them as athletes, train them that way, and encourage them to think of themselves that way. In many cases I might be the very first person or trainer to relate to them this way, as my running coach was for me.”
Plus-size model and prodigy positivity activist, ThickLeeyonce whose real name is Lesego Legobane, has been addressing and calling out people who alluded to her being unhealthy because of her weight and sparked a debate questioning the food choices of full figured people.
Taking to Twitter once, Thickleeyonce said:“I see skinny people tweeting about eating KFC for breakfast , no one will say anything about their health, but let me talk about craving chocolate at 8am, then everyone is a doctor who’s worried about my health.”
The diet culture that motivates people to strive to look thin can also create unhealthy relationships with food and those who are aspiring to be healthy.
Registered Dietitian and Association for Dieticians of SA (Adsa) spokesperson, Shani Cohen, says: “Successful weight loss is all about creating a healthy relationship with food and your body in the long term. Making small diet and lifestyle changes brings the best long-term gains. It is time to reshape our approach to losing weight.”
She says it all starts with your approach to what you’re eating: “Being mindful is an incredibly powerful tool. The secret to sustainable healthy eating starts with shifting your mindset and accepting that a healthy lifestyle is a journey. It takes time, experimentation, support and perseverance.
“You’ll need to adopt a more straightforward, relaxed and positive attitude to food. Think about food as a positive source of energy and sustenance, rather than a source of comfort, reward or a weapon.”
Green’s advice is to keep things simple:
In my practice I tell my patients that food shouldn’t be complicated – the more complicated the nutrition rules the more sceptical I am.
I keep it simple with my patients and always warn them to be savvy and sceptical consumers. If a diet is time limited and has a start and finish date, it will fail. In other words, if you are only making changes for a short period of time, you may very well revert to old bad eating habits.
Severe restrictions on our food intake are not sustainable. Different food groups provide all the nutrients we need, and following any diet that excludes whole food groups for any length of time is storing up other health problems for the future.”
Broaden your definition of health to include physical, social, spiritual and emotional health.
Losing weight and keeping it off requires adopting healthy behaviours in all areas of your life that influence weight gain.
Focus on healthy ways in which to deal with stress and emotions, ways that do not include food.
Start thinking about making permanent changes in yourself. None of this happens overnight, so it is important you remain kind and patient with yourself. You are not alone in this – so don’t be afraid to reach out. Confide in those you trust and experts who can guide and support you.
A healthy plate is one which you can thoroughly enjoy, one that can be shared with your loved ones and one that you feel confident will nourish your body to thrive, perform, grow and repair.
Before embarking on any diet, ask yourself “Can I eat like this for the rest of my life?” If the answer is no, it’s not a healthy lifestyle. It’s a diet.