Why Weight-Inclusive Care Matters in a Weight-Centric World
The beginning of each new year is always a fraught time to have a body. Just yesterday, I took the annual health survey required by our health insurance to “unlock” the activities needed to fund our HSA accounts, I was immediately confronted by everything I hate about the New Year.
Nowhere in this survey was there an option to say you were happy with how you are currently eating, moving, sleeping, or managing stress. It was simply assumed you need to be trying harder or striving to do better. Not to mention the heavy emphasis on BMI as a proxy for health and the two different programs being offered to “improve health” that really just focus on the same old weight-centric approaches of tracking food and movement, and the tired manta of “eat less, move more.”
The Weight-Centric Trap
Weight-centric (or weight-normative) paradigm is the default setting of healthcare in this country. It assumes that people in larger bodies are inherently in poorer health than their thinner counterparts. Consequently, weight loss is often the first, and sometimes only, treatment offered for a host of health issues ranging from diabetes to a sore throat.
This obsession with weight is a barrier to genuine well-being. It harms everyone, regardless of current body size. Those in large bodies are sacrificing mental, physical, and emotional health to reach an arbitrary number on the scale, using tactics scientifically proven to fail, just to prove they are “good” people. Meanwhile, those in smaller, socially acceptable bodies live in fear of their bodies changing, often using harmful, disordered approaches to food and movement to cling to their thin privilege.
But there is another way. Weight-inclusive or weight-neutral care knows that the size of one’s body is not a measure of one’s health. It shifts the focus from intentional weight loss as treatment and cure to prioritizing overall well-being. It promotes cultivating health supportive behaviors like eating in accordance with hunger and fullness cues from the body, finding ways to move that feel good to the individual, managing stress, prioritizing sleep, and body acceptance.
GLP-1 Medications: The Truth Behind the Hype
If Oprah still had her daily talk show, I can’t help but think the new version of “Everyone in gets a car!” would be “Everyone gets a GLP-1!”
“You get a GLP-1 and you get a GLP-1 and you get a GLP-1. Everyone gets a GLP-1!”
Why Ozempic and Wegovy Aren’t Changing the Paradigm
It seems like every commercial, doctor, and influencer is eager to tell you that this weekly shot (and now, daily pill) is all you need to lose weight and improve every aspect of your health. Ozempic, Wegovy, and Zepbound, are reshaping the conversation in America, but they aren’t changing the weight-centric paradigm – they are doubling down on it.
These drugs have allowed doctors to finally discuss the complexity of weight. They (sort of) acknowledge that “calories-in and calories-out” doesn’t work for many. They claim we need more options to support the more than 40% of population suffering from “relapsing remitting obes*ty”. (I hope you can hear the sarcasm dripping from the phrase.)
The Risks of Weight Cycling and Lifelong Medication
This is the weight-loss industry’s attempt to rebrand weight cycling, a well-documented independent risk factor for poorer health outcomes and increased mortality, as a “disease” that requires lifelong pharmaceutical intervention. Cha-ching for the drug companies.
I first wrote about my concerns with this new class of weight loss drugs in 2023, and they still stand. This “new approach” is the same old diet-cycle garbage dressed up in a fancy new package with an even fancier price tag. It does nothing to address weight stigma and anti-fat bias of our medical system, and that is bad news for everyone.
Not to mention current data shows:
Side effects from unpleasant and disruptive like nausea, vomiting, diarrhea and constipation to serious and life-threatening like pancreatitis, bowel obstruction, and acute kidney injury
Most people only take it for about a year (reasons vary from cost, insurance coverage changes, and untenable side effects)
Weight is regained when the medication is stopped, and even if you do keep taking it weight seems to plateau, and even start to tick-up, somewhere around the two-year mark.
Informed consent is an important part of the healthcare process. You deserve to know what to expect from a suggested treatment from a doctor. If your doctor isn’t giving you a full picture checkout this great resource from Medical Students for Size Inclusivity.
Diets Fail: The Myth of Willpower
The weight-centric “eat less, move more” paradigm has failed generations of humans. It has led to life-destructive eating disorders and guilt-filled years of disordered diet-focused eating. It flies in the face of the best research we have: Diets fail upwards of 95% of the time, and most people regain weight (and often a little extra) within two to five years.
People love to tell you what worked for them. “It is worked for me, so it will work for you.” My advice? Get back to me in 5 years and see if you are still spinning the same tale. My personal history includes “success” with calorie counting, Weight Watchers, intermittent fasting (back before it had a trendy name was just called “skipping meals”), running, low carb, paleo, and gluten-free.
None of these worked for more than a short period of time. None of them worked a second time because my body is much wiser than my brain, and it refused to be starved again.
“Willpower” is simply another way of saying “it’s your fault.” It is a distraction designed to keep you from looking behind the curtain of the flawed system.
I believe the only way out is to stop focusing on weight. I truly wonder what reduction in disease and improvement in quality of life we would see if we removed the systemic harm of weight stigma and the physiological harm weight cycling.
Biological Reality: Diversity is a Feature, Not a Bug
The weight-centric standard tells us body size equates to health. Biology tells a different, more inclusive story. We don’t look at someone’s height, shoe size, or eye color and assume they just didn’t try hard enough to be different. We accept these as natural genetic variations in humans. So, why do we expect every human fit into a narrow range of body size or shape?
Genetics and the Evolutionary Advantage of “Thrifty Genes”
Biological diversity has always existed, and it always will. Evolution, the “survival of the fittest” that you learned about in high school biology class, requires variety. If we were all carbon copies of one another, our species would be one environmental shift away from extinction.
Genes that allow for more efficient energy storage were a big biological advantage during times of widespread famine. Those “thrifty genes” were passed down because they kept our ancestors alive. And given the current state of climate change, those same genes might be lifesaving again in the future as food crops become harder to grow on a changing planet (tell me you’re reading Project Hail Mary without telling me you’re reading Project Hail Mary). What is categorized as a modern-day “problem” is actually evidence of the wisdom of the body, refined over millennia.
How Social Determinants of Health (SDoH) Influence Well-being
Biology doesn’t happen in a vacuum. Your health is influenced by the long tail of evolution, but also by the reality of your life. Research shows that body size and health outcomes are more heavily influenced by non-modifiable genetics and Social Determinants of Health (SDoH) than “willpower”.
Factors like your zip code, your access to safe green spaces, air quality, and financial security have a far greater impact on your well-being than any choice you make at the grocery store. Some studies suggest that only about 30% of health is influenced by health behaviors which includes alcohol, drug, and tobacco use, sexual activity along with diet and exercise. I have seen some state as low as 10% of that is related to diet and exercise alone. A shocking number to many of us who have been told diet and exercise is everything.
Furthermore, we cannot talk about biology without acknowledging the impact of your lived experience. Adverse Childhood Experiences (ACEs) and early-life trauma can literally recalibrate your physiological stress responses and metabolic function. For many, a larger body may have been a survival mechanism. A biological response to a nervous system that never felt safe.
Understanding Your Body's Genetic Setpoint
The setpoint theory argues that your body as a genetically determined weight range, your setpoint. This range is easily maintained by responding to internal cues like hunger and fullness and the desire for movement. When you try to force your body below this setpoint, like through a weight loss diet, it fights back. Hunger and cravings increase, while energy levels drop.
Trying to lose weight can also raise your setpoint to protect against the threat of future starvation. Your body doesn’t know food is available and you are choosing not to eat it or eat enough of it. That is not the biologically logical choice, so the body assumes the worse and responds accordingly.
Dieting is a consistent predictor of weight gain. Up to two-thirds of people who diet eventually gain back more weight than they originally lost. Your body isn't "failing" a diet; it is successfully protecting you from what it perceives as a famine.
Working with Your “Right Now” Body
You can’t go back in time and avoid that first, second, or tenth diet. You can’t change your genetic blueprint, your past exposures to stress and the environment, or your childhood address. But you can choose to stop fighting with yourself today.
A big part of weight-inclusive care is body respect - accepting your body exactly as it is right now. Accepting that there are things about your body and your health that you may never be able to fully change.
It may take some time to settle into your body as it is today and to accept that it may continue to change. And your weight may not be and may never be what you wish it was.
Many of us think we will finally like ourselves after the scale moves, but the truth is that you cannot hate yourself into a better relationship with your body. If that worked, it would have worked by now.
Your body is on your team. It is doing everything it can with the information it has to keep you alive. When we ignore these systemic and biological realities, we aren't practicing healthcare; we're practicing shaming.
Weight-inclusive care recognizes that you cannot "lifestyle" your way out of your genetics or your history. Instead of fighting against our biological blueprints, we can finally start working with them.
Shifting the Focus: Health Beyond Weight
If we agree that weight is not a reliable proxy for health, what is? The answer lies in shifting our focus from outcome (the number on the scale) to behaviors (the things you do to support your body).
Why Scale is a Distraction from Sustainable Habits
One of the biggest problems with a weight-centric approach is the scale is, more often than not, a saboteur of progress. How many times have your started a habit that made you feel good like a daily walk that buoyed your mood, or adding fruits and veggies to your meals that helped regulate your bowel movements, only to quit because the scale didn’t move that week? Thinking “why bother? It isn’t working anyway.” But it was working, your mood was improved and sluggish gut finally felt regular despite the number on the scale.
When we tie our efforts to a number we cannot fully control, we often throw out life-changing, health-supporting behaviors simply because they didn't "work" to shrink our bodies. Weight-inclusive care is about keeping the behaviors because of how they make you feel, not how they make you look.
Non-Scale Victories – Proof of Progress
In the diet world, people often talk about "non-scale victories" (NSVs). While the concept is helpful, the phrase often carries the baggage of rigid programs like Whole30 (a diet in sheep’s “food freedom” clothing). Instead, I like to think of these as Proof of Progress. These are the tangible, physiological signs that your body is being well-cared for:
Improved Energy: Not needing a third cup of coffee to survive the afternoon.
Mental Clarity: Being able to focus and engage without "brain fog."
Body Comfort: Noticing fewer aches, better digestion, or improved mobility.
Stable Mood: Feeling more resilient in the face of stress.
Clinical Markers: Improvements in blood pressure, blood sugar stability, and cholesterol levels that happen independently of weight change.
Resources for the Shift
If you’re ready to shift to a more weight-inclusive approach, here are a few places to start:
Intuitive Eating 101: The 10 Principles – The foundational framework for healing your relationship with food.
Gentle Nutrition: Eat Healthy Without Diet Rules – How to nourish yourself without the rigidity of "good" and "bad" labels.
Interoceptive Awareness: The Science of Intuition – Learning how to hear and trust your body's internal signals.
The Truth About Weight Loss and Intuitive Eating – A deeper look at why "success" isn't measured by the scale.
Ditching Diet Culture: Anti-Diet Eating Takes Effort – Validating the hard work of unlearning a lifetime of diet rules.
Intention is Everything: Reclaiming Healthy Behaviors from the Grips of Diet Culture – How to move and eat for you, not for a goal weight.
Choose Respect over Restriction to Reclaim Health
Ultimately, this is about reclaiming what "health" actually means. Health is not a moral mandate; you are not a "better" person because you are healthy, and you aren't "failing" if you are ill. And a small body certainly doesn’t equate to health.
Weight-inclusive care is about making health accessible to everyone who wants it. The path to well-being doesn't require you to shrink yourself to fit into a system that was never designed for your unique biology or history.
Weight-inclusive care is not "anti-health"—it is the most pro-health stance we can take. It allows us to stop fighting a war against our own bodies and start investing in the behaviors that actually make our lives better today.
You deserve healthcare that sees the whole human (the Whole You, if you will), not just a number on a scale. You deserve to move, eat, and rest in a way that feels like kindness, not punishment.
Take the Next Steps:
Reflect: What is one health-supporting behavior you actually enjoy—completely independent of its impact on your weight? Start there this week.
Audit Your Care: The next time you're at the doctor’s office, remember you have the right to healthcare without a side of stigma and shame. Ragen Chastain has some great printable resources to help you have a conversation with your providers.
The information provided is for educational and informational purposes only. It is not intended to be medical advice or to diagnosis, treat, cure or prevent any disease. This information does not replace a one-on-one relationship with a physician or healthcare professional. Dietary changes and/or the taking of nutritional supplements may have differing effects on individuals.
To learn more about how working with a nutritionist could help you, schedule a free 15-minute call.