A No-Diets Approach – Dietitians are changing the way they discuss nutrition

A paradigm shift is occurring in nutrition and dietetics. A no-diets approach to health is being incorporated into many university degrees and being utilised by a growing number of dietitians.

Now you may be wondering why dietitians wouldn’t use diets to help patients and clients. Isn’t there an ‘Obesity Crisis’ and isn’t helping people to lose weight what a dietitian does?

Let’s find out more

The ‘non-diet approach’, sometimes shortened to ‘NDA’, is a method health professionals can use to support community members to make health behavior changes without a focus on weight loss.

There are four main reasons why many health professionals don’t recommend weight loss programs or diets as a means for good health anymore:

1. Diets don’t work

For the majority of people, weight loss techniques do not work in the long term. For example, results of a 2013 systematic review showed many people can lose weight initially, but after 2-5 years they return to their previous weight. This is the case whether advice is given from a Dietitian or accessed through community-based programs.

2. The relationship between weight and health is complex

The standard advice patients will have often received in the past is that if they lose weight, their health concerns like diabetes, high cholesterol or high blood pressure will improve. Yes, this can most definitely happen. The nutrients associated with such health conditions (such as saturated fat, added sugars and salt) are often found in foods with a higher amount of energy (or calories). Therefore, when we follow a weight loss diet, our health can sometimes improve.

However, contrary to popular belief, living in a larger body is not necessarily “bad for our health”. There are studies showing people who simply focused on healthy behaviours (and not weight) have improved their health and this happened even when their weight stayed the same.

In fact in a large population-based study investigating healthy lifestyle habits, participants eating ≥5 fruit or vegetables/day, taking part in regular exercise of ˃12 times/month, having moderate alcohol consumption and not smoking had a lower risk of mortality regardless of body mass index (BMI).

3. Weight loss diets can be harmful

There is emerging evidence repeated dieting is associated with a higher risk of developing disordered eating and body dissatisfaction.

Additionally, weight cycling where our weight goes up and down (which is what happens when we frequently diet) has been associated with negative health effects. These include lowered HDL-cholesterol (the good one), increased incidence of diabetes, hypertension, and cardiovascular events such as stroke and myocardial infarction (heart attack). It’s also hypothesised increases in inflammatory responses in the body due to weight cycling may be linked to some of these negative health effects.

4. Judging someone by their weight is a discrimination issue

Given the research on the effectiveness and potential harm from dieting, we now know focusing health promotion strategies on body weight and assuming larger bodies are more unhealthy than smaller bodies is a social justice issue. It is viewed by some as a form of discrimination. Therefore, many universities are now including discussions on social justice and weight stigma in their nutrition and dietetics curriculum.

How are dietetic students learning the non-diet approach?

Australian universities are now offering a more diverse mix of learning opportunities in the non-diet approach. Students are:

• gaining a chance to research the effects of social media and marketing strategies on body image
• learning to review the literature and evidence for using body mass index (BMI) with patients and clients
• researching weight discrimination within health systems and its impact on equity of access to health care
• practising counselling skills to apply in clinical settings, particularly with community members who have been dieting for years. Students are learning how to support people to make changes to eating that are health and not weight focused.

How are practising dietitians using the non-diet approach?

The non-diet approach is really a practical application of the Health-at-Every-Size® (HAES ®) movement. (You can read more about HAES ® here).

Dietitians working across a broad range of settings are all able to apply HAES ® and the non-diet approach into their work. When it comes to patient and client consultations, they might use it by:

• Supporting patients to learn and practice mindful eating. This helps them to eat according to their body cues of hunger, fullness and satisfaction
• Providing nutrition education and practical meal planning ideas to improve health without recommending suggested portion sizes or using prescriptive meal plans
• Assisting their patients to find joyful means of exercise for the purposes of health and happiness (and not for weight loss)
• Providing strategies that can help patients accept and embrace their body shape
• Using non-weight based health outcomes to measure their effectiveness. For example, changes in patients’ blood glucose, blood pressure and cholesterol levels, and levels of mindful eating.

Want to learn more?

• For patient/client materials and further information on HAES ® philosophies go to The Association for Size, Diversity and Health
• Check out Health-at-every-size (HAES®) UK for connecting with UK HAES ® and non-diet approach informed practitioners
• Look for training opportunities such as those offered by Well Now (UK) and Health, Not Diets (Australia)
• Contact your local health service to learn more about any available community programs like this Well Now program delivered through NHS Highland.

Let’s Start Talking…

1. Is anyone currently using the non-diet approach in your workplace?
2. Are there ways you could be more weight-neutral in your profession?

Share your thoughts and experiences by commenting on this blog or joining a conversation on twitter by tagging @AHPScot and @ChristinaAPD

About the Author…

Christina Turner is an Australian Accredited Practising Dietitian who specialises in Eating Disorders and the Non-Diet Approach. She currently works as Senior Teaching Fellow and Internships Coordinator in the Master of Nutrition and Dietetic Practice program at Bond University.

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