How to Let your Clients’ Desire for Weight Loss Be OK
Even when you don’t believe anymore
These days, people are quite willing to advise people in larger bodies about what they need to do with their body. On the left, is the most common and controversial choice: lose weight. This choice, however, is growing more and more stigmatized. Clinicians have watched the harms experienced by pursing the thin ideal, often resulting body dissatisfaction, dieting and other unhealthy weight control practices. The desire to protect their clients is real and important.
Alternatively, is the encouragement for people in larger bodies to accept their bodies and/or focus on improving their health behaviors, without a focus on weight loss or the scale. For those, however, who really do feel that they would like to reduce their body size, it may not be enough to just practice health behaviors without any real target to focus on for change.
Typically, those who have been the loudest voices in this conversation have been thin and young. As advocates, these voices have use their privilege to advocate against weight stigma and anti-fat bias. However, where are the voices of those who actually have to live in these larger bodies? Further, where are the opinions on the experiences of being fat, particularly from those who are older?
I enter this discussion from two insightful positions: I have lived in a larger body for many years AND I am a researcher who helps people improve their eating behaviors and manage their weight. I have a vantage point that I believe helps me understand. I know the journey of accepting your body. Further, I intimately know the desire to lose weight, and the consequences, albeit physical or social, if you choose not to.
I also know who participates in my research studies. Older women. Folks over 45. The people who are experiencing the consequences of obesity and are desperate for change. Often, these adults share stories of pain. Their knees may hurt. They report difficulty climbing stairs, caring for loved ones, and their quality of life is reduced. Weight stigma is rarely discussed, if at all. They lead with wanting to do what they can to improve the remaining days of their life.
The debate between clinicians who support weight loss and the ones who don’t is ugly. And our clients are caught in the crossfire. Armed with their personal stories and motivations for wanting to change their life, they enter our offices. What do they encounter?
As clinicians, how do we make room for those who believe pursuing this choice is what is best for them and avoid the slow creep into paternalistic notions and guidance?
Further, how do we lead with a heart that listens, rather than one that tries to convince the other that their way is flawed? How can we let people be in charge of their own destinies, honoring the wisdom they have without assuming we know better?
We remember motives matter.
Several pieces of evidence indicate that motives for weight loss, in fact, do matter. Those who have appearance motives vs. health-motives for weight loss appear to have the worst outcomes in weight management programs. Indeed, individuals motivated to lose weight for appearance were more likely to use unhealthy eating strategies, have higher concerns about body image, and are more likely to engage in binge eating, compared to those who would like to lose weight for health reasons.
Much of our conversation has not weighed the impact of motives on our guidance. We may incorrectly assume that too many attempts at weight loss have to do with achieving the thin ideal and/or responding to internalized messages of weight stigma, when in fact, that may be further from the truth. With evidence that even 5% weight loss can improve cardiovascular health for our clients, perhaps our guidance MAY need to be a bit more nuanced.
We remember there are multiple ways to obtain health.
Our treatment plans should include options, one that will meet our clients at all stages. After doing our assessment, we should make room for the multiple paths that someone desires to take for health, even if that may include weight loss. How do we make room to help more? We could design treatment plans for clients at various different stages, e.g. 1) recovering from disordered eating and needing to make peace with food, 2) desiring health, but no weight talk; 3) wanting to lose weight. Though limits will be necessary, particularly in the presence of disordered eating behaviors, our work should ultimately begin with where our clients are in their journey.
In conclusion, though we can acknowledge the harms done by “diet culture” and a societal focus on achieve majority norms of the thin-ideal, I hope we can also see that for many, there may be alternative, health-related reasons that undergird the desire to pursue weight loss. We have to leave room for free choice and starting where the client or patient is on their journey. Moreover, clinicians would do well to recommend strategies that may provide avenues to help from multiple starting points.
Rachel is a clinical social worker and researcher who designs programs to help people find freedom in their relationship with food. She lives in Charlotte, NC.
References
1.Vartanian LR, Wharton CM, Green EB. Appearance vs. health motives for exercise and for weight loss. Psychology of Sport and Exercise. 2012;13(3):251–256.
2. Schelling S, Munsch S, Meyer AH, Margraf J. Relationship between motivation for weight loss and dieting and binge eating in a representative population survey. Int J Eat Disord. 2011;44(1):39–43.
3. Putterman E, Linden W. Appearance versus health: does the reason for dieting affect dieting behavior? J Behav Med. 2004;27(2):185–204.
4. Goode RW, Kalarchian MA, Craighead L, et al. The feasibility of a binge eating intervention in Black women with obesity. Eat Behav. 2018;29:83–90.
5. Goode RW, Kalarchian MA, Craighead L, et al. Perceptions and experiences of appetite awareness training among African-American women who binge eat. Eat Weight Disord. 2018.
