A Size-Acceptance Approach
to Health Promotion
By Joanne P. Ikeda, M.A., R.D.
From Radiance Fall
People are often told that the only way they can be healthy is to lose weight. They are
advised to achieve this by restricting calories and increasing physical activity. However,
scientific studies document that of the persons who lose
weight using this approach, 95 percent to 97 percent regain the weight within
five years. Michael Schwartz and Randy Seeley, biochemists at the
University of Washington, explain that "most forms of obesity are likely to
result not from an overwhelming lust for food or lack of willpower but from powerful
biochemical defects at one or more points in the system responsible for body weight."
They go on to say that "the use of energy restriction [that is, calorie restriction]
to normalize body weight of an obese person has little likelihood of long term
Although National Institute of Health (NIH) experts insist on weight
loss as the goal of weight management programs for obese
individuals, they admit that there is little information regarding the health benefits or
risks of long-term intentional weight loss. Thus we have a situation where people are
pressured to achieve the unachievable, with little evidence that it could ever be of
benefit to them.
Because they find the research base for the traditional paradigm (restrict calories and
increase exercise) unconvincing, some health professionals are recommending a new model.
It is based on the belief that although we may not be able to help fat people lose weight
permanently, we can help them improve their health and reduce their risk of chronic
disease. Recent research supports this idea. In a study of more than
twenty-one thousand men of varying body sizes, researchers at the Cooper Institute in
Texas found that unfit, lean men with a body mass index (BMI) of 25 or less had twice the
risk of mortality from all causes than fit men who were overweight with a BMI of 27.8 or
greater. Results of the Dietary Approaches to Stop Hypertension (DASH)
study demonstrated that individuals could lower their blood pressure in
only two weeks by eating more fruits and vegetables and less saturated fat. This
improvement in health was independent of weight loss.
Our current challenge is to develop programs that celebrate the benefits of a healthy
way of life: programs that promote body satisfaction and the achievement of realistic and
attainable health goals without concern for weight change.
Programs should never promote body dissatisfaction, low self-esteem, restrained
eating, eating disorders, or the attainment of an idealized body size
With this challenge in mind, health professionals began talking with one
anotherat meetings and conferences, on the telephone, and over the
Internetabout how to establish standards for a nondiet, size-accepting
approach to health. To our alarm, beginning in the mid-1990s, some people have
jumped on the bandwagon of nondiet, size-acceptance programs, but their goal
still has been to get clients to lose weight. Either they have prescribed diets without
calling them diets, or they have confused size acceptance with a lack of size prejudice
(not promoting size discrimination is not the same as size acceptance). Size acceptance
means saying that a person is okay at the size she or he is right now, and that one does
not have to lose weight in order to be healthy or to become healthier.
Clearly, both health professionals and consumers needed some guidelines for recognizing
what constituted a true nondiet, size-acceptance approach to health.
Within three months several professionals from various health-related
fieldswith advice from many other health care professionalsdeveloped the
"Tenets of Size Acceptance." *
Here is the fruit of our efforts, which we hope will help to guide both other health
providers and those clients who turn to them for their services. ©
Send comments or questions to Joanne P. Ikeda, M.A., R.D., Department of Nutritional
Sciences, University of California, Berkeley, CA 94720; 510-642-2790; (fax) 510-642-0535;
e-mail : firstname.lastname@example.org.
Tenets of Size Acceptance
- Human beings come in a variety of sizes and shapes. We celebrate this diversity as a
positive characteristic of the human race.
- There is no ideal body size, shape, or weight that every
individual should strive to achieve.
- Every body is a good body, whatever its size or shape.
- Self-esteem and body image are strongly linked. Helping people feel good
about their bodies and about who they are, can help motivate and maintain
- Appearance stereotyping is
inherently unfair to the individual because it is based
on superficial factors over which the individual has little or no control.
- We respect the bodies of others even though they might be quite different
from our own.
- Each person is responsible for taking care of his or her body.
- Good health is not defined by body size: it is a state of physical, mental, and social
- People of all sizes and shapes can reduce their risk of poor health
by adopting a healthy lifestyle.
Appel, L. J., T. J. Moore, E. Obarzanek, W. M. Vollmer, L. P. Svetsky, F. M. Sacks, G.
A. Bray, T. M. Vogt, J. A. Cutler, M. M. Windhauser, L. Pao-Hwa, and N. Karanja. "A
clinical trial of the effects of dietary patterns on blood pressure." New England
Journal of Medicine (1997;336:11171124).
Barlow, C. E., H. W. Kohl III, L. W. Gibbons, and S. N. Blair. "Physical fitness,
mortality and obesity." International Journal of Obesity (1995;19 (suppl
Kassirer, J. P., and M. Angell. Editorial: "Losing weightAn ill-fated New
Years resolution." New England Journal of Medicine (1998;338:5254).
Robison, J. I., S. L. Hoerr , K. A. Petersmarck, and J. V. Anderson. "Redefining
success in obesity intervention: The new paradigm." Journal of the American Dietetics
Schwartz, M. W., and R. J. Seeley. "The new biology of body weight
regulation." Journal of the American Dietetics Association (1997;97:5458).
* In particular, I want to acknowledge the contributions of Karen Petersmarck, Ph.D.,
M.P.H., R.D., nutrition consultant with the Michigan Department of Community Health;
Jonathan Robison, Ph.D., codirector of the Michigan Center for Preventive Medicine;
Professor Sharon Hoerr, Ph.D., in the department of Food Science and Human Nutrition at
Michigan State University; Illinois dietitian Janet Sundberg, M.S., R.D.; nutritionists
Mary Fujii, J.S., R.D., and Carol Powell, M.A. (both at University of California
Cooperative Extension); health educator and coauthor of Great Shape, Pat Lyons; Dayle
Hayes, M.S., R.D., a Montana dietitian and coauthor of Moving Away from Diets;
Madeleine Sigman-Grant, Ph.D., Cooperative Extension nutrition specialist at the
University of Nevada.
this is only a taste of what's inside the printed version of the magazine!