“Weight What?” – Shifting towards Weight Inclusivity in Mental Healthcare with Clinical Dietitian Adee Levinstein, RD, LD, CEDS-S

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Posted Under: Insights

Clinically Reviewed by: Amanda Fialk, PhD, LCSW, LICSW

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This post recaps a virtual continuing education event for mental health professionals, hosted by The Dorm and featuring a presentation by Adee Levinstein, MS, RD, LD, CEDS-S from Eating Recovery Center, a national leader in eating disorder treatment with 35 locations across the country. 

For those of us struggling with body image or disordered eating, it can be almost impossible to escape the blaring reminders and not-so-subtle comments about body weight, shape, and size. There’s a good reason for this: the growing weight-management industry is valued at over 142 billion dollars, and weight loss fads are made profitable by marketing to individuals at an increasing volume through social media. Working within this “weight-centric” cultural backdrop, many clinicians and mental health providers are beginning to advocate for a framework of weight inclusivity within healthcare that dismantles the belief that thin equals healthy. 

In a recent collaborative event with Eating Recovery Center, Clinical Dietitian Training Specialist Adee Levinstein, RD presented an overview of weight inclusive care for mental healthcare providers. In the following article we summarize key takeaways from Levinstein’s presentation and a few insights about how we promote weight inclusivity and an “anti-diet” mentality into mental health treatment at The Dorm.

Primer: A Closer Look at the Relationship Between Weight & Health

Adee begins the presentation by explaining how there are several societal mechanisms in place that have skewed our understanding of the relationship between weight and health.  

“As clinicians, we’re taught that as long as we provide the right knowledge about food and nutrition, it will lead to different choices, which will then lead to weight changes, and then health changes,” she says. “But what we actually know is that it’s more complicated than this.”

  • The weight loss industry has a lot of influence on popular culture. 

Health providers need to be constantly aware of the financial stakes in the weight loss industry in promoting the belief that that weight loss equates to better health. The multi-billion dollar weight loss industry is a large factor in why health is seemingly so tied to weight. This industry capitalizes off of insecurities and runs on sales of weight loss programs, diet plans, food plans, classes, exercise gear and clothing. 

  • There is a lack of diversity in the research on weight and health. 

Levinstein adds that there is a fundamental problem with research into weight loss and eating disorders, because the available research we have on weight & health lacks diversity.  “The research that is out there is only as objective as the humans who are providing it,” she says. For instance, the BMI was developed based on the average body size of a European male – and didn’t account for other nationalities or genders, rendering it useless for quality measurements across the population. 

  • There are no studies that show a diet or fitness routine that leads to long-term health outcomes. 

Most surprisingly, research in weight loss has focused on short-term or intermediate results of weight loss, and almost never examines the long term effects, she explains. It’s common for participants in a study to exhibit rebound weight gain in the long term, because the behaviors they were asked to emulate for the study are not sustainable. 

Levinstein also cites recent research suggesting that weight loss is not consistently associated with lower mortality risk – for instance, heart health can be improved with exercise training completely independent of weight loss. In summary, “weight is not directly correlated to health,” explains Levinstein, and “just looking at numbers on a scale does not fully encompass all the factors that affect health.”

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  • Healthcare providers often underestimate the socioeconomic factors of health and overestimate diet and exercise. 

“The thing that we’re mostly focusing on is diet and exercise, which – don’t get me wrong, I’m a dietitian and I believe movement and nutrition are hugely important to health – and we cannot talk about them in isolation from the other factors of a client’s life. If we’re not talking about these other things, the nutrition and exercise piece isn’t going to significantly impact their health if they don’t have the other things in place. – If someone is working three jobs and taking care of their kids and is extremely stressed, trying to eat one more vegetable a day isn’t going to be the thing to move the needle.” 

What does weight inclusive care look like?

The traditional approach in discussions about health, also known as the “weight-centric” approach, ties weight and weight management strongly to health outcomes. However, we know from research that if we just look at numerical values, we miss so many other factors that also relate to health. This is why it is important to use a weight-inclusive approach to health, which emphasizes health and well-being without tying that to weight loss. Weight-inclusive care highlights the importance of health-promoting behaviors, and features care that is person-centered and aligned with values.

A weight inclusive approach:

  • can allow for less healthcare provider avoidance
  • helps decrease disordered eating patterns and feelings of shame and guilt around food
  • teaches appreciation for body diversity
  • increases attunement to body cues
  • encourages a patient to choose sustainable behaviors in their health journey

Identifying Health Promoting Behaviors

Beyond getting balanced meals and adequate nutrition, Levinstein emphasizes that weight inclusive healthcare promotes a large variety of health behaviors, including getting enough sleep, engaging in social relationships, going to therapy, resting, and aligning your actions to your values.

Values-Aligned Health Goals

Weigh inclusivity celebrates when bodies are able to work and function properly, rather than talking about shape and size. 

One way to help clients understand this is to ask them about their favorite things to do and make the connection between nutrition & movement practices. For instance, “Say I’m working with an older client and their goal is to sit down on the floor and have energy to play with their grandchildren.” That is a values-aligned health goal rather than a goal that’s been driven by the weight loss industry or other fear-based motivation. 

Family Therapy

Levinstein also reminds us that families live in the same world that we live in, and have often also been exposed to the same messaging that a lower weight equates to health. In many cases, it is important to provide education to the entire family (with empathy) to promote supportive language around bodies. Helping them “unlearn” these associations while being understanding of their perspective can be extremely beneficial for them as well as the client’s recovery process.

Neutral Language Around Food

In supporting individuals with eating disorders and disordered eating patterns, Levinstein explains that it is key to use neutral language around food, such as “nourishing,” “appetizing,” and “satisfying.” Words like “good,” “bad,” “clean,” and “allowed” associate food with either a positive or negative connotation, which can affect the way someone may think about food, and in turn affect their recovery process.

The Dorm’s Approach to Weight Inclusivity & Eating Disorder Treatment

At The Dorm all of our clients complete a comprehensive nutrition assessment regardless of their primary diagnosis, because we know that food and mood are closely connected and that eating disorders may often go undetected. Our eating disorder treatment is part of a holistic model of IOP and PHP care that supports clients through an affirming and inclusive community, and provides young adults with an individualized treatment plan including individual therapy, clinical coaching, skill-based learning and group therapy. As part of this, our nutrition philosophy offers a respectful, individualized, and stigma-free framework of care that utilizes three main models: Health at Every Size, Intuitive Eating, and Freedom From Diet Culture, all of which foster a supportive environment of weight-inclusive care. 

Health at Every Size (HAES)

Health at Every Size is an evidence-based model that allows our clients to feel further at peace with their bodies by celebrating body diversity, challenging cultural norms, and rejecting stigmas around weight. As is consistent with current research, HAES believes that instead of BMI and weight, which have been proven to be inaccurate measures of health, other indicators of well-being, such as behaviors and mindset, are better ways to measure health. 

Intuitive Eating

Intuitive Eating helps clients learn to identify obstacles of body respect, address and improve negative thought patterns, and respond to hunger and fullness cues. It allows for an individualized approach to a client’s eating recovery process.

Freedom from Diet Culture

Freedom From Diet Culture teaches clients to step away from the rigid expectations associated with dieting and diet culture, such as valuing thinness over health. Diet culture increases body dysmorphia, disordered eating, eating disorders, and other mental health issues, and has overall been proven to be extremely harmful to a person’s relationship with their body and food. We at The Dorm strive to maintain a diet-culture-free environment to prevent these harmful thoughts and behaviors and help clients feel welcome in our community. 

Thank You ERC!

Weight-inclusive care centers the individual, not a certain shape or size, and helps our clients  focus on healthy behaviors rather than numbers on a scale. We were so grateful to partner with Eating Recovery Center whose approach to food and movement aligns with our own – as well as to Adee Levinstein’s expertise and the work she is doing to shine a light on weight inclusive care.

To learn more and continue the conversation – check out the event Q+A session below, where Adee and Amanda respond to questions about helping adolescents find body acceptance, the craze about Wegovy, and helping clients resistant to change. 

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