Dietitian and health advocate Lucy Aphramor tells Michelle Thomas why it’s time to stop focusing on weight gain and target hate speech instead.
Too fat, too thin, too confident. It seems nobody can win. And according to Lucy Aphramor, the current public health focus upon weight-loss could actually be doing more harm than good. As an experienced dietitian, supporter of Health At Every Size and the founder of health-gain approach The Well Now Way, she explains the real implications of bodyshaming.
Surely health isn’t exclusively determined by our height/weight ratio? What about cholesterol levels? What about blood pressure? What about mental health? These things can’t be determined by our size alone, can they?
You’re right. It’s nonsense to suggest you can reliably tell someone’s health from their size (or body mass index). When you look at the number on the dial you can tell my weight. You can’t know my eating habits, diet history, activity levels, whether or not I smoke, how much I drink.
You don’t know about other important factors that impact health – my work status, sleep patterns, income level, worries, challenges or life history. There is a bigger picture to health and wellbeing that the focus on weight management eclipses. This is not saying diet and exercise don’t influence health or quality of life. They do. It’s saying diet and exercise don’t make as much difference to health outcomes as public health campaigns suggest they do.
Why do we assume weight indicates health status?
Politically, it’s a neat way of blaming disadvantaged people for the health consequences of being disadvantaged and enabling the advantaged to carry on regardless, maybe even oblivious. Scientifically, it’s a mystery. The focus on weight as a measure of health is not just bad science, it’s counterproductive. In any culture that merges weight, health and moral worth, focusing on weight as a measure of health leads to size stigma and thin privilege. As with all forms of oppression and privilege, this has human rights implications.
“Remind yourself that you are, and always were, worthy of respect. Treat yourself kindly. Accept yourself. Even if you wish you were different.”
In fact it increases health inequalities in several ways. Living with size stigma (or bodyshaming) is linked to disrupted eating behaviours. It gives the impression that there’s no point sustaining changes in diet, activity, or other self-care behaviours, unless you lose weight. Promoting the thin=healthy equation is premised on the assumption we can recommend something – dieting – to get people thin. Someone who is going to lose weight will lose weight and achieve weight stabilisation with a focus on health-gain and body respect. The big difference is that those people who don’t lose weight hear the message of body respect for every body and are also supported to take care of themselves.
But diet and exercise are an enormous factor in wellbeing?
Of course – just imagine not eating any fruit or veg for two weeks! But public health messages present an exaggerated view of the role of diet and exercise in determining population health. Research has found that lifestyle has some impact on health – but social class has much more impact. Social class impacts health partly through differences in diet and exercise but a far greater impact is seen through stress responses associated with being treated badly: in other words, a lack of respect. The stress response influences blood pressure, blood stickiness, artery health, insulin resistance and other metabolic pathways linked to heart health, diabetes, and hypertension. What research like this shows, is that in real terms an unhealthy lifestyle is not so much down to diet and exercise as it is to being subject to harassment, to having our opinions devalued, our identity invalidated, our appearance ridiculed, our voice silenced.
So what should we be aiming for?
I’ve said that BMI is not a reliable indicator of health. In terms of measuring wellbeing it’s more relevant to focus on variables that are more reliable, such as blood pressure, insulin sensitivity, heart health and a whole gamut of variables on mental wellbeing. People of all weights can have high blood pressure, diabetes, heart problems. Weight and health aren’t one and the same thing: just ask a fat rugby player, or a thin person living in food poverty. It is very possible to be fat and healthy, and thin and unhealthy.
Remind yourself that you are, and always were, worthy of respect. Treat yourself kindly. Accept yourself. Even if you wish you were different.
Why is bodyshaming so harmful?
We expect people to justify their health but the chatter on health and weight is a distraction from the real issue. Oppression is linked to health inequalities, so shouldn’t oppressive behaviour be a priority area of research? It would be a far more effective health promotion strategy to get off people’s backs about their weight and instead focus attention on changing the climate that leads to behaviour such as hate speech. If we want to promote good health we need to ensure no one is subjected to shaming comments on their appearance and judged negatively because of their actual – or imagined – health status.
“Research shows that in real terms an unhealthy lifestyle is not so much down to diet and exercise as it is to being subject to harassment, to having our opinions devalued, our identity invalidated, our appearance ridiculed, our voice silenced.”
How does Health At Every Size work?
The HAES philosophy promotes a focus on health gain. The treatment premise is that supporting people to make long-term improvements in health behaviours leads to improvements in physiological and psychological measures in people of diverse weights whether or not weight changes.
In short, HAES practice holds that promoting respect for all supports healthy behaviours for everybody and reduces psychological distress related to size discrimination and body shame. It works by supporting people to move away from diet-mentality thinking and learn to listen to their body signals and respond to cues for self-care which might be around food, movement, sleep, a hug and so on. This shift away from weight-control to health-gain and self-care helps people to sustain the behaviour change that may have eluded them for years as dieters.
For more information on The Well Now Way visit www.well-founded.org.uk4490 Views
Blogger. Feminist. Person with manners. Author of Healthy, Happy, Hot (Unbound), https://unbound.co.uk/books/healthy-happy-hot