Weight-Inclusive & Fat-Positive Care Explained
Today, we are answering some of your burning questions surrounding weight-inclusive and fat-positive care. For example: what is the difference between weight-normative and weight-inclusive care? Do weight-inclusive providers not care about health? Are fat-positive providers glorifying “ob*sity"? Isn’t “body positive” more inclusive than “fat-positive?"
Imagine going to the doctor for a sore and swollen ankle that you fear could be broken. As you are brought back into the office, the nurse instructs you to step on the scale. You wobble and pose like a flamingo since you can’t stand on both feet. The nurse asks you to be still. You think: “hmm do they know I’m here for an ankle injury?”
Once the doctor arrives, they manipulate the ankle, causing you to wince in pain, as you explain that you haven’t been able to put any weight on the foot for 24 hours now. The doctor says that it is probably just sprained, but if you really want to get an x-ray they can order one. You don’t feel much relief from their words so you request to move forward with an x-ray. To your relief, it is not broken but a grade 2 sprain where the ligament is slightly torn. After the doctor inevitably says “I told you so,” they explain how using ice and elevating your foot can help with the discomfort. Without skipping a beat, the doctor goes on to explain how increasing your fruit and vegetable intake, laying off the sweets, and going to the gym more often will help you to lose weight…
The doctor doesn’t know that you’ve sprained your ankle from stumbling on the stair-master at the gym during your regular workout. They also don’t know that you’ve followed an ethically-based vegan diet for the past eight years and consume a variety of foods including fruits and vegetables. The doctor doesn’t know that you are three years recovered from a restrictive eating disorder.*
This is a somewhat extreme, but completely realistic, example of weight-normative and fatphobic healthcare in action. Notice the unsolicited and irrelevant (not to mention not scientifically or medically based) weight loss advice, the assumptions made about a person based on their body shape and/or size, plus assuming that weight loss is desired, health-enhancing, and appropriate.
A 2014 article in the Journal of “Ob*sity” defines the weight-normative approach to healthcare as “hav[ing] an emphasis on weight and weight loss when defining health and well-being”, and the weight-inclusive approach as having “emphasis on viewing health and well-being as multifaceted while directing efforts toward improving health access and reducing weight stigma.”
A weight-normative approach, as the name suggests, is the more common paradigm used in the Western medical field today. It is important to note that the weight-normative paradigm does not stop at doctors and nurses, but is common throughout healthcare professions like dietitians, physical therapists, chiropractors, psychologists, and therapists.
Alternatively, the weight-inclusive approach recognizes that health is much more complex than the number on the scale, bodies come in all different shapes and sizes, weight stigma is harmful, and intentional weight loss should not be recommended. Intentional weight loss recommendations are not only ineffective, but also harmful, as it increases the likelihood of weight-cycling (the gaining and losing of weight repeatedly) which increases the risks of binge eating, cardiovascular disease, chronic inflammation, and even mortality.
Plus, recommending weight loss greatly perpetuates weight stigma. A 2016 paper explained that 53% of women with “ob*sity” report hearing inappropriate comments about their weight from healthcare professionals. Instead of focusing on body weight (something that is largely influenced by factors out of one's control), weight-inclusive providers take a more holistic approach by looking at the person as a whole.
In case it isn’t obvious, all providers at Feed & Flourish Nutrition Therapy take a weight-inclusive approach. We believe that the health and wellness of individuals is as unique as their genome; there is no one-size-fits-all approach to nutrition, movement, or body image. We look to improve folks' quality of life, treat them with dignity and respect, and encourage health-promoting behaviors that focus on sustainability, rather than their weight. There is a misconception that weight-inclusive providers do not care about health, but that couldn’t be further from the truth! This falsity comes from the inaccurate assumption that dieting and intentional weight loss are health-promoting behaviors.
Perhaps at this point, you may see the benefits of a weight-inclusive approach, but are you feeling on the fence about this idea of “fat-positive health care”? This hesitancy makes sense as someone living in diet culture who has been taught that “fat” is synonymous with words like “lazy” or “unhealthy”. When we live in a culture that holds so many negative assumptions about people living in larger bodies- some radical change is needed to make people in larger bodies feel seen, safe, and accepted. Hence, the need for fat-positive care! The term itself “fat-positive” brings attention to the word fat- helping to reclaim it as the neutral descriptive term it was meant to be. Besides providing decent, respectful care to its patients, fat-positive care providers are usually also doing advocacy work and aiming to end weight discrimination. The NAFA (National Association for Fat Acceptance) website notes that “fat people who also represent other marginalized identities are disproportionately impacted by anti-fatness, in addition to the challenges they face because of other biases and oppression in our culture.” Fat-positive care doesn’t stop at accepting the size or shape of one's body, but additionally considers the intersectionality of one's identity, with the goal of liberation for all.
Fat-positive care is essential because of the marginalization that fat bodies endure every day in this society. Fat-positivity and fat-positive care are not about exclusion and that “fat is better”, but rather fat-positive care is meant for all bodies by celebrating and focusing on the most oppressed. But isn’t celebrating and focusing on people in larger bodies “glorifying ob*sity”?! This problematic phrase is derived from fatphobia. Does any other identity get called out for being “glorified”? Remember the words “ob*sity” and “overw*ight” are pathologizing, problematic terms that hold the inaccurate assumption that being at a higher body weight infers disease. Keep in mind that in 2o13 American Medical Association (AMA) asked its own Committee on Science & Public Health to examine if “ob*sity” should be labeled as a disease. Though the committee concluded NO, it does not meet criteria, the AMA disregarded its own experts and declared “ob*sity” to be a disease. There is big money in disease, but I digress, that could be a topic for another day!
The bottom line is:
people in larger bodies getting affirming, respectful care isn’t glorifying anything, it is providing a basic human right.
All providers at Feed & Flourish Nutrition Therapy are weight-inclusive and fat-positive. All are welcome here. If you are looking to cultivate a more peaceful relationship to food and body, you have come to the right place. Now accepting new clients, learn more here.