Body-Positive Medicine

By Dr. Deanna McCrary, ND

What is body-positive medicine?  Isn’t all medicine body positive?  Sadly, not always.  The medical community often over-emphasizes lower body weight as a goal to reach and maintain in order to “achieve” health. The idea that a person can achieve metabolic health while being at a weight outside of the accepted norms is often viewed as suspect at best and medical heresy at worst.  But is there a way to overall health other than by focusing on body weight?

Fortunately, the old views are starting to change—slowly.  More and more research is showing that traditional dieting does not work in the long-term and, often leads directly to even more weight gain.  Also, patients are more likely to engage in physical activity if it is something that they already do that feels fun and pleasurable, and can be part of their daily life.

Further, recent studies have shown that excess body weight may actually have a protective health effect and prolong life rather than shorten it.  “In study after study, overweight and moderately obese patients with certain chronic diseases often live longer and fare better than normal-weight patients with the same ailments. The accumulation of evidence is inspiring some experts to re-examine long-held assumptions about the association between body fat and disease,” states Harriet Brown in a September 17, 2012 New York Times article titled “In ‘Obesity Paradox,’ Thinner May Mean Sicker.”

What Does “Body-Positive” mean?

To define the phrase “body positive” I will paraphrase the principles of Health at Every Size® (HAES®) as coined by the Association for Size Diversity and Health,  HAES is a health-care movement that is synonymous with body positivity and in this article I will use the terms interchangeably. To be body-positive one accepts and respects that there is natural diversity in body size and shape.  Recognizing that health and well-being are multi-dimensional and include physical, social, spiritual, occupational, emotional, and intellectual aspects, a body positive person promotes all aspects of health and well-being for people of all sizes.  A body-positive person eats in a manner which balances individual nutritional needs with hunger, satiety, appetite, and pleasure.  They engage in individually appropriate, enjoyable, life-enhancing physical activity, rather than exercise focused on a goal of weight loss.

To be body-positive does not mean that one has reached some blissful state of 100% body-acceptance or intuitive-eating nirvana without a shred of judgment toward oneself or others, but we are on the road, reading about it, talking with others, putting some of these ideas into practice, and increasing our awareness.

What traits do health care providers who embrace these tenets have in common?
Here are a few:

Patients Are Treated Equally

Body-positive providers are “weight neutral” and recognize that people naturally come in many different shapes and sizes and that size alone is not an indicator of overall health.  They will not immediately assume a patient has a certain health condition because of their size. They make an appropriate assessment of a patient’s health and risk factors only after getting a full history from the patient including a physical exam and any lab work or imaging studies.  For example, when meeting a patient for the first time, a HAES-focused provider would never immediately assume that a fat person binges on fast food, never exercises, has diabetes or high blood pressure, nor would they immediately assume that a thin person eats healthfully, exercises regularly, is anorexic, has brittle bones or could not have diabetes or high blood pressure.  Some of these things may end up being true but they are uncovered as a result of doing an impartial intake and not before. All patients are treated equally and are offered the same treatment and examinations given to anyone with similar symptoms or lab results, regardless of body size.

Also, a body-positive health care provider uses weight-neutral, non-stigmatizing language.  Terms such as “obesity” or “overweight” are highly charged with negative connotations that reflect a perceived disease state rather than a normal body type that may be perfectly healthy.  A HAES-focused provider would not use such terms.

No Weight-Loss Lectures

“Prescriptions to lose weight set people up for feelings of failure and deprivation and a lot of other difficulties, including teaching [patients] not to trust their bodies,” states Linda Bacon, PhD, a nutrition professor and author of the book, “Health at Every Size: The Surprising Truth About Your Weight.” And she should know.  She conducted a randomized, controlled-trial of the HAES® approach and found it is “… associated with statistically and clinically relevant improvements in physiological measures (e.g., blood pressure, blood lipids), health behaviors (e.g., eating and activity habits, dietary quality), and psychosocial outcomes (such as self-esteem and body image), and that HAES achieves these health outcomes more successfully than weight loss treatment and without the contraindications associated with a weight focus,” according to Bacon’s paper in Nutrition Journal, “Weight Science: Evaluating the Evidence for a Paradigm Shift.”

Patients Are Not Weighed at Each Visit (Generally) and BMI Is Not Used

Although there are times when it may be medically necessary to track a patient’s body weight, for example if the patient has a body-wasting disease such as cancer or anorexia, or, conversely a condition that may cause rapid weight gain such as certain thyroid conditions or Cushing’s disease, a body-positive health care practitioner will not weigh a patient at each visit.  If they are required to do so by the patient’s insurance company, they will be discreet and empower the patient with the option to know the number or not.

The Body-Mass Index, or BMI, is commonly used in the medical community as a measure of fatness in patients.  The BMI was developed to be used on adult male populations only and not individuals.  Further, it does not distinguish between fat, bone and muscle when determining body weight, so its usefulness in clinical assessment has been called in to question.  You can read more about the BMI here:

Their Offices Accommodate and Welcome All Sizes

Health care providers who operate from a Health At Every Size® perspective strive to make their offices friendly and accommodating to persons of any size.  They will have a variety of blood pressure cuff sizes, sturdy chairs that don’t sit too low to the ground, patient gowns that comfortably fit both large and small bodies and an examination table with a wide, stable step-up.

They have books or magazines in the waiting area that celebrate the variety of sizes that people come in and refrain from having books or periodicals that are about restrictive diets, weight loss schemes or that glorify one body type while disparaging others (whether directly or implied).

They Empower Patients

Being weight-neutral and body positive doesn’t mean that discussions about good nutrition or the benefits of exercise are never discussed.  However, such providers speak more about adding in nutrient dense foods that will specifically help a condition, and less about restricting foods.  Traditional diets or food restriction with a goal of weight loss can easily back-fire.  It is human nature to want what we can’t have.  A person who feels forced by someone else to restrict certain foods (often ones they really enjoy) or a whole food group can develop an even greater desire for it than before.  This is the essence of why diets don’t work and often result in weight gain in the long-term.  A body-positive health care provider is aware of this phenomena and will help a patient release the “food police” from duty, celebrate with them the habits they already have that contribute to good health and help them uncover and remove other habits that may be obstacles.  They assist a patient in learning to cue in to hunger and satiety cues that may have been long-lost after years of restrictive dieting, and find reasonable, enjoyable physical activity in their natural body size—whatever that may be.

They work with the patient as a team, giving the patient a voice and a role in their treatment options.  Rather than lecturing patients by blaming or shaming them for previous choices, they seek to empower patients by offering knowledge, guidance, motivation, acceptance and inspiration.

They Have Examined Their Own Prejudices

It is virtually impossible for anyone in our society not to have culturally conditioned assumptions and biases regarding body weight.  The popularity of shows such as “The Biggest Loser” which reinforce simplistic and extreme “calories in-calories out” models of weight management are testament to our country’s obsession with weight loss not only as a health cure-all but also as catharsis to our collective fears about the social and economic consequences of weight and the perceived redemptive qualities of releasing it.  Body-positive providers have examined their own relationship to food, weight and exercise and continually seek to recognize and challenge their own internal biases when they come up.

A body-positive provider has educated themselves about the social and psychological stressors for people who fall at either extreme in the weight spectrum.  They have found ways to be accepting and compassionate about such a patient’s experiences.  They also recognize that people within the normal weight spectrum often have negative views about their bodies, their relationship with food or exercise and may perceive flaws in themselves that others might not see.  This is the heritage most of us have from living in a fat-phobic, weight-obsessed culture.

Body-positive providers have educated themselves about eating disorders and are able to identify and respond to the conditions in their patient’s lives that contribute to body image and disordered eating.

Based on the criteria above do you feel your health-care providers are body positive?  We would love to hear about your experiences.