WHY BE AN ADVOCATE FOR HAES = HEALTH AT EVERY SIZE

Transcription

1 WHY BE AN ADVOCATE FOR HAES = HEALTH AT EVERY SIZE JOANNE P. IKEDA, MA,RD NUTRITIONIST EMERITUS DEPARTMENT OF NUTRITIONAL SCIENCES UNIVERSITY OF CALIFORNIA, BERKELEY

2 WHAT IS HEALTH?.Health is a state of complete physical, mental and social well being and not merely the absence of disease or infirmity. Preamble to the Constitution of the World Health Organization as adopted by the International Health Conference, New York, June, 1946; signed on 22 July 1946 by the representatives of 61 States (Official Records of the World Health Organization, no. 2, p. 100) and entered into force on 7 April The Definition has not been amended since 1948.

3 HEALTH = WEIGHT = Physical Health Blood Pressure Triglycerides Plasma Glucose C-Reactive Protein Insulin Resistance HDLs, LDLs, Cholesterol Weight/Waist Circumference/BMI

4 MENTAL HEALTH Self-Esteem Body Image Happiness Measures Body Satisfaction/Body Dissatisfaction Self-Efficacy Quality of Life Scale Satisfaction with Life Scale

5 SOCIAL HEALTH Social health is one's ability to form meaningful personal relationships with others. It is also an indication of one's ability to manage In social situations and behave accordingly. Nurturing Relationships Safe, Stable Environments Health Equity

6 WHAT HEALTH PROBLEM HAVE WE DECLARED WAR ON?

7 FOR OVER 65 YEARS WE HAVE ADVOCATED CALORIC RESTRICTION OF FOOD INTAKE AND INCREASED PHYSICAL ACTIVITY AS THE TREATMENT FOR OBESITY We have no research proving this treatment is effective in the long term. We have no proof that it results in reduced risk of chronic disease or increased life span.

8 LOOK AHEAD The Look AHEAD (Action for Health in Diabetes) study was a multi center, randomized controlled trial, designed to determine whether intentional weight loss reduces cardiovascular morbidity and mortality in overweight individuals with type 2 diabetes. Began in Enrolled 5,100 patients. Ended early in 2012 based on a futility analysis.

9 Intensive Lifestyle Control Group = Usual Care Initial Weight 8 yr. ILI Loss ILI Final Weight 8 yr DSE Loss DSE Final Weight Female 209 lb 9.31 lb. 199 lb 4.6 lb 204 lb Male 240 lb 1.09 lb 238 lb 3.4 lb 236 lb Average Wt Loss 5.2 lb 4 lb. Drop Out Rate Beginning Ending Retention Rate Drop Out 5,100 patients 821 patients 16% 84%

10 DIETING CAN BE HARMFUL TO HEALTH Promotes notion that those who are not successful are out of control, lazy, stupid. Increases prejudice against those who are obese and overweight Reinforces social isolation and stigmatization of those who are obese and overweight Leads to yo yo dieting/weight cycling. Increases risk for chronic disease

11 OTHER POTENTIAL HARM? Raises false hope Focuses on weight as the most important thing rather than lifestyle Those who are not successful blame themselves. Lowers self esteem Raises body dissatisfaction Increases risk of eating disorders Difficulty making friends, finding partner

12 NHANES DATA * Looked at Cardiometabolic Risk factor clustering Blood Pressure Triglycerides Plasma Glucose C-Reactive Protein Insulin Resistance HDLs, LDLs, Cholesterol Body Height, Weight, & Waist Circum *Wildman RP et al. The Obese without cardiometabolic risk factor clustering and the normal weight with cardiometabolic risk factor clustering.arch Intern Med. 2008, Aug 11; 168(15):

13 METABOLICALLY NORMAL VS ABNORMAL Obese Adults, 20 years % metabolically normal 68.3% metabolically abnormal Overweight Adults, 20 years+ 51.3% metabolically normal 48.7% metabolically abnormal Normal Weight Adults, 20 years+ 76.5% metabolically normal 23.5% metabolically abnormal

14 CONCLUSION OF THE RESEARCHERS Among US adults, there is a high prevalence of clustering of cardiometabolic abnormalities among normal weight individuals and a high prevalence of overweight and obese who are metabolically healthy.

15 HAES = WEIGHT NEUTRAL HEALTH FOCUSED 1.Weight Inclusivity: Accept and respect the inherent diversity of body shapes and sizes and reject the idealizing or pathologizing of specific weights.. 2.Health Enhancement: Support health policies that improve and equalize access to information and services, and personal practices that improve human well-being, including attention to individual physical, economic, social, spiritual, emotional, and other needs.

16 3. Respectful Care: Acknowledge our biases, and work to end weight discrimination, weight stigma, and weight bias. Provide information and services from an understanding that socio-economic status, race, gender, sexual orientation, age, and other identities impact weight stigma, and support environments that address these inequities. 4. Eating for Well-being: Promote flexible, individualized eating based on hunger, satiety, nutritional needs, and pleasure, rather than any externally regulated eating plan focused on weight control. 5. Life-Enhancing Movement: Support physical activities that allow people of all sizes, abilities, and interests to engage in enjoyable movement, to the degree that they choose.

17 WEIGHT FOCUSED VS HEALTH FOCUSED Weight Focused Health Focus(HAES ) Weight Aim for a certain weight Body will seek its natural weight when individuals eat in response to cues Food Good/bad, legal/illegal, should/shouldn t etc. Quantity/quality determined by external source (calories, grams, exchanges) ALL food is acceptable Quantity/quality are determined by responding to physical cues (hunger/fullness, taste, etc.) Physical Activity Exercise to lose weight Aim to be more active in fun and enjoyable ways

18 RESEARCH IN SUPPORT OF HAES Intervention Diet Group Non-Diet = HAES Calorie restriction and food diaries Read food labels/fat grams Exchanges Benefits of exercise Encouraged to walk at certain intensity Body acceptance/self-worth Techniques to focus on internal cues vs. external cues Nutrition- effects of food choices on well-being Activity that allowed them to enjoy their bodies Bacon et al, 2002; Bacon et al, 2005

19 RESEARCH IN SUPPORT OF HAES Results Depression Body Image Self Esteem Diet Group No significant improvement at 2-year follow-up Non-Diet Significant improvement at 2-year follow-up Labs No significant changes at 2-year follow-up Significant changes in Total Cholesterol, LDL, Systolic BP at 2-year follow-up Drop Out 41% drop out rate 8% drop out rate? Weight Lost weight, then gained Maintained weight Bacon et al, 2002; Bacon et al, 2005

20 RESULTS OF RESEARCH IN SUPPORT OF HAES 6 Studies HAES/non-diet groups experienced improvements in: physiological measures (e.g. blood pressure, blood lipids) health behaviors (e.g. physical activity, eating disorder pathology) psychosocial outcomes (e.g., mood, self-esteem, body image) No studies found adverse findings in the HAES/non-diet groups Bacon et al, 2002; Bacon et al, 2005; Ciliska, 1998; Goodrick et al, 1998; Mesinger et al, 2009; Miller et al, 1993; Provencher et al, 2007; Provencher et al, 2009; Rapport et al, 2000; Tanco et al, 1998

21 IMPACT OF NON DIET APPROACHES ON ATTITUDES, BEHAVIORS, AND HEALTH OUTCOMES: A SYSTEMATIC REVIEW JNEB MARCH APRIL, 2015 VOLUME 47, ISSUE 2, PAGES E1 16 STUDIES Improved blood lipids glucose, and blood pressure Increased body image, self esteem, physical activity; Improved dietary patterns Decreased dietary restraint and disinhibition, emotional eating, and eating disorder symptoms Low drop out rates

22 WHAT NOW? In the doctor s office, ask about your metabolic indicators of health. Have a list of them ready. Teach children to appreciate people based on the way they treat others not on how they look. Speak up when you see or hear size discrimination. Don t make negative comments about your own body or the bodies of others. Advocate for funding for research on HAES.

23 TO FIND OUT MORE ABOUT HAES Association for Size Diversity and Health extensive resource section Win the Rockies a community based HAES program Health At Every Size Curriculum to inform Health Professionals & College Students

24 All men dream, but not equally. Those who dream by night in the dusty recesses of their minds, wake in the day to find that it was vanity: but the dreamers of the day are dangerous men, for they may act on their dreams with open eyes, to make them possible. T. E. Lawrence

25 Q & A Session