Most of us are taught that to be thin is to be healthy. But what if that isn’t true?
The question haunted dietitian Dawn Clifford 20 years ago when, as she was helping her patients with weight loss, a colleague who specialized in eating disorders pulled her aside and said, “You’re creating more patients for me.”
“I believed there were ‘healthy’ weights and ‘unhealthy’ weights, and my practice was very weight-centric at that time,” said Clifford, a professor in the Department of Health Sciences at NAU. “My patients kept losing weight and then gaining it all back because that’s just how our bodies are wired. I realized I wasn’t helping them at all; I was causing more harm.”
That’s when Clifford kicked off her research journey into weight-inclusive health care. She found research that challenged everything she’d believed about weight and health. One study showed that people who were “overweight” according to the Body Mass Index scale tended to live longer than people who were a “normal” weight. Another literature review found that most people with larger bodies who lose weight through diet and exercise tend to regain the weight. Multiple studies have concluded that there’s a distressingly high rate of undiagnosed eating disorders among higher-weight people.
“Health care professionals want to do no harm, but studies are finding that when health care practitioners recommend weight loss or take a weight-centric approach in caring for their patients, there are serious risks involved—including a life of unsafe yo-yo dieting and the development of an eating disorder,” Clifford said. “There is more and more research coming out that supports a weight-inclusive approach both for mental and physical health.”
To help future practitioners embrace a more compassionate approach to dietetics, Clifford and a handful of her health sciences colleagues are integrating weight-inclusive messages into their teaching. They use case studies that feature larger patients, model inclusive language that helps those with a higher weight feel supported on their health journey and help students create nutrition plans that focus on patients’ overall well-being and disease management instead of weight loss. They also use their classroom experiences to publish peer-reviewed papers on how to incorporate weight-inclusive perspectives into health sciences teaching to inspire a more empathetic approach to care, providing guidance and food for thought for their peers.
“The truth is, weight is just one way of looking at health,” Clifford said. “I believe in evidence-based care, and the evidence shows that weight-inclusive care is the best way to promote health and happiness.”
Teaching compassionate care
Nikole Squires, a lecturer in NAU’s fitness wellness degree program, is proof that weight-focused health advice can be harmful. As a college student majoring in athletic training, Squires developed anorexia nervosa. While working with student-athletes as part of her hands-on training, she noticed she was far from alone.
“I saw where a lot of it came from—coaches had a certain idea of what an athlete’s body should look like in a certain sport, and they would make comments if the athletes’ bodies looked different than that idea,” Squires said. “Trainers and dietitians around them would be like, ‘Here are the resources you can use to lose or gain weight,’ instead of, ‘Here’s what you can eat or how you can train so you have more energy and better sleep and better performance.’”
While in recovery from anorexia, Squires started researching weight-inclusive practices on her own, eventually completing a master’s degree in health and kinesiology at the University of Utah. During her master’s program, she read Clifford’s systematic review on non-diet approaches to health, and it inspired her to come to NAU for her Ph.D. Together with two other faculty members, Clifford and Squires are now leading the charge to teach weight-inclusive care strategies to Lumberjacks who will become tomorrow’s providers.
“There are a lot of students in our classrooms who might see weight as a personal responsibility that is directly linked to individual behaviors rather than something that’s very complex and that involves genetics and social determinants of health,” Clifford said. “We try to gently challenge that view with questions and examples that get them thinking critically about how many factors contribute to someone’s weight and health.”
Squires likes to use rural communities as an example, given how rural Coconino County is outside of Flagstaff.
“It’s fine to say, ‘Eat more fruits and vegetables and exercise more,’ but if someone only has access to the gas station rather than a full grocery store, or if they live off a highway with no sidewalks, that’s easier said than done,” Squires said. “With weight-inclusive care, we can focus on behaviors while also realizing everyone’s life circumstances are different.”
‘Every body is welcome’
In addition to teaching and publishing research, Clifford and Squires run NAU’s low-cost University Coaching for Activity and Nutrition (UCAN) program, which helps students, faculty and staff achieve health and well-being goals like reducing stress, achieving self-acceptance and incorporating more movement into their lives. They’re also focused on promoting size diversity in health care professions.
“Oftentimes, individuals at higher weights feel like they’re not going to be accepted in the profession they’re choosing, like personal training or dietetics,” Clifford said. “I think it’s so important to send the message to our students that every body is welcome in all health and fitness professions. We need diverse bodies in health care.”
The pair also supported the founding of the Weight Inclusive Research in Education (WIRED) collaborative, an international network of weight-inclusive educators and researchers. Last summer, they convened experts from around the world at a WIRED conference in Flagstaff. They also stay in contact with weight-inclusive professionals through the Arizona Health at Every Size Think Tank and the Weight Inclusive Dietetics Educators Facebook groups.
Squires said it’s encouraging to see weight-inclusive care—once considered a fringe movement—gain momentum.
“If there’s a default norm and it goes unquestioned for a long time, people get pushback when they question it,” Squires said. “We used to think the sun rotated around the Earth, and people who believed the Earth rotated around the sun were called heretics for hundreds of years until the heliocentric model was accepted. When you can’t dispute the evidence, that’s when things start to change. I think we’re starting to see similar evidence in favor of weight-inclusive care.”
Jill Kimball | NAU Communications
(928) 523-2282 | jill.kimball@nau.edu