A Size-Acceptance Approach 
to Health Promotion

By Joanne P. Ikeda, M.A., R.D.

From Radiance Fall 1999

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 success."

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 and shape.

With this challenge in mind, health professionals began talking with one another—at meetings and conferences, on the telephone, and over the Internet—about 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 fields—with advice from many other health care professionals—developed 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 : jikeda@socrates.berkeley.edu.

References

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;336:1117–1124).

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 4):S41–S44).

Kassirer, J. P., and M. Angell. Editorial: "Losing weight—An ill-fated New Year’s resolution." New England Journal of Medicine (1998;338:52–54).

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 Association (1995;95:422–423).

Schwartz, M. W., and R. J. Seeley. "The new biology of body weight regulation." Journal of the American Dietetics Association (1997;97:54–58).

* 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; and Madeleine Sigman-Grant, Ph.D., Cooperative Extension nutrition specialist at the University of Nevada.

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