The belief that weight loss improves health is so strong. Yet the research is not as strong as you would think. Worse, we don’t have research to suggest that any weight loss strategy will last, especially not when you look 2-5 years out. And we have research to show that weight cycling (gaining and losing significant amounts of weight) is metabolically harmful.
So if not weight loss, how do you improve your health?
The 3 Approaches to Weight in Healthcare
There are three different approaches to weight:
- Weight-centricThis approach starts with the assumption that high body weight is bad and therefore you must lose weight, even if your health is fine now.
- Complication-centricThis approach reads the research to mean that high body weight can be associated with negative health and therefore if you are able to lose weight, it is likely beneficial, but the benefits must outweigh the harms.
- Weight-neutral or weight-inclusiveThis approach looks at the research and concludes that weight has a much lower impact on health than those in camps 1 and 2 think and the harms associated with intentional weight loss patterns are much higher than they think. Additionally, the natural variation of bodies is larger than those in camps 1 and 2 believe. This is the camp I fall into and wrote a whole article on this topic.
I agree that the claims on the benefits of weight loss are overblown and the risks are under-appreciated, particularly the mental health risks and weight-cycling risks. Additionally, the focus on weight leads people to make changes that miss the true mark.
When people are looking to improve their health, feel better or have more energy, the goal is to be able to go out and just live your life without your health or fear holding you back. But once you start setting weight loss goals, even if it initially is in service of those bigger goals, it is easy to fall into short-term thinking.
That type of focus leads people to make changes that may cause weight loss in the short term but cause harm in the longer term. This is the unsustainability that we see in weight loss plans all the time. The plans are not built for long-term success; they are built for short-term hype.
But what if I still want to lose weight?
If you fall into the complication-centric approach, we can still work together and have conversations. The research around weight is so challenging because there are so many factors at play and I can see how a person might come to the complication-centric conclusion.
However, the line between weight-centric and complication-centric is pretty small. Weight bias is deeply embedded in our healthcare system, health research, and society at large. Many wonderful people are working on intuitive eating, body positivity, and fat activism. All of these movements and communities have different focuses and there are conflicts because of that.
I am completely against a weight-centric approach. There are absolutely no health benefits to being thin simply for the sake of thinness. The only benefit is caused by the weight-centric belief. The weight-centric belief is tied directly to diet culture, weight bias, and weight stigma and these are things that we, as a society, should work to eradicate. Judgement serves no one.
The research is such that it can be interpreted in both a complication-centric or weight-inclusive way. Doing solid research is difficult, especially in complicated fields like health, wellness, and weight. This is why we have multiple approaches when it comes to “weight management.”
What about using Ozempic (or other medication) for weight loss?
These medications do cause some amount of weight loss for a statistically significant number of people who take prescription weight loss mediation, like Ozempic. The questions are: Does that weight loss last? Does that weight loss lead to health improvement? And more importantly, is that weight loss essential to health improvement?
The counterpoint to those questions is that many studies show that you can improve blood pressure, cholesterol, diabetes management, and more by improving how you eat, move, sleep, and think (stress management), without any change on the scale.
I am skeptical of anything with a lot of hype. I’ve seen too many things come out with a big bang and letting us down — the results either don’t last or there are complications that we didn’t know about until more people have used the product or followed the protocol.
In the case of Ozempic, I wouldn’t particularly recommend it. However, if I had a client who had the conversation around risks and benefits with their doctor and chose to take it, I would absolutely support them in that journey by helping them build a positive relationship with food, and their body, regardless of the scale.
What about meal timing? Does intermittent fasting help?
I find the intermittent fasting trend so odd. For years, I have seen clients come to my office who skip breakfast, sometimes lunch as well, and they are coming to me with diabetes, high blood pressure, and high cholesterol. It is just a strange shift to happen in a fairly short period of time.
For the clients that I have worked with, the most common meal timing, that works for the most number of people, is to eat within the first hour or so of waking and then every 3-6 hours after that, with your final meal about 3 or 4 hours before bed.
The specific timing will vary depending on how much you eat at a sitting and how quickly you digest that food. Some of that is based on personal choice and preference on how full you want to feel. If you prefer to feel the stretch of your stomach and feel full, you’re going eat more than if you are simply seeking a neutral sensation where you are no longer hungry. And when you eat less in one sitting, you’ll need to eat more often.
Some of it is genetic — some people are not very fuel efficient so they need to eat more frequently because they need to eat more food. This will also vary based on your stage of life. Think of a toddler or a teenager who is approaching a growth spurt versus someone who is in their 40s.
As with everything in nutrition, there are always exceptions. If you feel good having two meals a day — have the energy to go about your day, feel satisfied (but not over-full) after meals, and get all your nutrition in — then it might work for you.
If you have diabetes, you have an extra layer of complexity, but also a way to look under the hood. By testing your blood sugar, you can find out if your body can manage the amount of carbohydrates and food you are eating at those meals. If you test before and 2 hours after, you can see whether there was too much. (Be sure to confirm the recommendations regarding the targeted rise with your medical team.)
Additionally, if you go low between meals, that is an obvious sign that you either need to eat more or have a snack between the meals. If you have a continuous glucose monitor, it will help to capture these moments a bit easier, but you can also pay attention to symptoms and test with a finger poke.
Meal timing also affects other health conditions. For example, larger, less frequent meals can be associated with higher blood cholesterol, particularly if you are having higher fat (especially saturated fat) meals or eating more sugar as that can be converted as well.
Is it true that I shouldn’t eat after 7 pm?
It’s true that you shouldn’t eat a large meal just before going to bed. The main reason for that is that you’re likely to have heartburn or poor sleep if you do so.
Your last meal of the day should be at least 3 or 4 hours before bed, to ensure that you don’t have a lot of food still being actively digested. However, if you are hungry before bed, a small snack is recommended. Your sleep quality is not going to improve by going to bed hungry.
You just want to keep the snack relatively small — enough to satisfy, but not so much that you feel full at all.
How do I manage all my different health problems?
It can feel very overwhelming to figure out how to change your diet and lifestyle to manage multiple health problems as some health problems can have conflicting recommendations. However, for the conditions that most commonly occur together, the recommendations are the same!
When we look at high cholesterol, diabetes and high blood pressure, the recommendations are virtually identical. It’s also really similar to what I recommend for an anti-inflammatory diet for arthritis!
- Less processed foods are also
- Lower sodium
- More satisfying
- More nutrient dense
- More plants, especially beans, nuts, and seeds, give you
- Higher potassium
- Lower saturated fats
- More fibre, particularly soluble fibre
- Nuts, seeds, and legumes are specifically recommended for heart health
- Diets high in whole grains, fruits, and vegetables are also recommended for general wellbeing
- More omega-3 fats (fish, nuts, and seeds) are both anti-inflammatory and positive for heart health
- Move every day in some way helps your body in numerous ways
To help you get there, prioritize balanced meals. A good starting point is 1/2 plate veg, 1/4 starch, 1/4 protein — also helps you get more plants! Then experiment and incorporate some of the smaller details as you go.
If you have been struggling with your weight, consider the possibility that your focus on weight is what has been holding you back. What would it feel like to instead prioritize feeling good and doing the things you want to do?
What would it mean to eat well if you didn’t have to worry about your weight?
What would it mean to respect and appreciate your body for being the vessel that allows you to interact with the world? It may be imperfect, especially as a person with chronic pain and fatigue, but it still allows you to connect with other humans. You are still here.
How can you have fun moving your body?
If you are just starting on your health journey or you are struggling to do all the things, check out the Bare Minimum Health Plan eBook to get started: