Although I make no secret of the fact that I practice a health-first, not weight-focused approach, weight loss comes up day after day, especially this year with the pandemic.
I get it. If you don’t fit into the “normal” weight category, you’ve likely heard from health professionals, your family, and the media that you should be smaller. You may well be convinced of it yourself.
The desirability of weight loss is seldom questioned, especially where heart health is concerned.
I’ve covered this before (here and here), but essentially, because (1) we don’t have a diet that reliably and safely produces significant weight loss in the long run, and (2) we have evidence that weight loss doesn’t help people actually avoid future heart problems, I gently shift the conversation away from this. I don’t like to set people up for failure.
You may know people who’ve lost weight on diets, but how many do you know who’ve kept it off for more than a year or two? How about five years? There are some for sure, but they’re in the minority.
But if not weight loss, what?
So where do we go from there?
My approach is to ask, “What makes weight loss important to you right now? What do you hope it will do for you?” Then we put our heads together and see if we can address those underlying goals and desires.
Usually in my practice, the answer starts with “I want to be healthier” or some variation of that. Sounds good… so what does that really mean to you?” We spend a few minutes clarifying the answer to make sure we both understand the real goal(s).
“I don’t want to have another heart attack.” Now we’re getting concrete. “I want to live longer, to be here for my family.” Yes! I love to hear that.
Other common answers… “I don’t want to develop diabetes” or “I want to control my blood sugars better.” Smart. I’m there for it.
Sometimes the answers point more at physical fitness, mobility, strength, and energy. “I don’t want to be out of breath just from climbing the stairs” or “I want to be able to move around more easily.” “I just felt better when I weighed x pounds.” Absolutely makes sense.
Harder to address
Some answers are harder to address. “My clothes don’t fit.” “I’m not comfortable in my body.” “I don’t like the way I look.”
Those are every bit as understandable. Sadly, our culture places a lot of importance on physical appearance. Trust me when I say I wish I had a solution to these perfectly valid concerns.
I want to support people’s right to pursue the goals that matter most to them, but the reality is that I don’t have a secret weight loss diet hiding up my sleeve. No one does.
All I can do is hold space for the difficult conversations, support people in tackling what we can control, and refer them to other professionals when appropriate.
The good news
So is there any point to watching what you eat? Of course! 😉
If improved heart-health is the goal, we’ve got something to work with. Nutrition plays a big role in reducing the risk of future heart problems, and we have evidence-based, proven strategies that work, even without weight loss.
Certainly these factors might all improve even more with weight loss, but if it’s only temporary, is that helpful? Repeatedly losing and regaining weight (aka weight cycling) may be as problematic as conventional wisdom tells us excess body weight is. (It’s unclear.)
Similarly, physical functioning (and cardiovascular risk factors) can significantly improve with movement, even in the absence of weight loss. Nutrition can play a supporting role, and I make sure to reinforce what people are doing in terms of physical activity, referring them to qualified exercise professionals when possible.
It might take some grieving and time, but letting go of weight loss as a measure of health can be incredibly liberating. You might find it helpful to focus on other measures, like blood pressure, blood sugar control, strength, how far you can walk, Mediterranean diet score, or sleep.
I’ve developed a standard assessment I now give all patients at the start and end of treatment with me, so we know we’ve made progress, even if it’s not measured in pounds.
There’s nothing wrong with wanting to lose weight. I just try to shift the focus to other goals, which may provide the wellbeing you’re actually after, and in case weight loss doesn’t happen. Our bodies are pretty stubborn in that respect.
I wish you could meet some of the strong, confident, energetic people I’ve known over the years who have shifted their mental energy, time, and assessment of self-worth towards living, giving, loving, and enjoying life instead.
It may go against everything you’ve been told, but I invite you to consider it. Your heart will thank you.
I want to acknowledge the generous weight-inclusive dietitians who helped me frame my thoughts about this vexing topic, particularly supporting people around body image: Renee Little, Bronwyn Coyne, Maria Ricupero, and Kristyn Hall.