Embracing a Weight-Inclusive Approach in Healthcare: A Call for Change

Content notice: medicalized fatphobia, anti-fat language, obesity

The prevailing weight-centric model in healthcare has long been predicated on the assumptions that weight is a direct determinant of health, that body size can be used to predict one’s individual health, that body size is responsible for various diseases, and that weight is under an individual’s control [1]. Nearly 1 in 5 Canadian physicians believe that patients with higher weight tend to have “bad behaviours”, and more than 1 in 4 feel that patients with obesity are often noncompliant with treatment recommendations [2].

This perspective, however, is increasingly being challenged by a growing body of evidence suggesting that a weight-inclusive approach, which emphasizes health behaviors and holistic well-being rather than body weight, can lead to better health outcomes [1]. This commentary examines the evidence supporting weight-inclusive care, highlights the detrimental effects of weight-centric practices, and proposes actionable strategies for medical professionals to align with weight-inclusive care.

The Evidence for Weight-Inclusive Care
Weight-inclusive approaches, such as Health at Every Size (HAES), advocate for the acceptance of body diversity and focus on health-promoting behaviours regardless of weight [3]. Six randomized controlled trials conducted between 1998-2007 suggest that a HAES approach to healthcare counselling is associated with statistically and clinically relevant improvements in physiological measures (e.g., blood pressure, lipid profiles), health behaviours (e.g., physical activity, dietary intake), and psychosocial outcomes (e.g., mood, self-esteem, body image) [4]. Additionally, when studies control for factors like fitness, activity, nutrient intake, weight cycling and socioeconomic status, the correlation between BMI>30 and disease risk either disappears or is significantly reduced [4].

The Harms of Weight-Centric Care
Weight-centric care can be dangerous. Promoting weight loss, even gently, contributes to weight bias and discrimination, leading to societal stigma [5]. As a result, patients may delay or avoid medical care, be less likely to seek recommended screening for some types of cancer (breast, cervical, colorectal), and may present with more advanced, difficult to treat conditions [1]. These factors may partially explain associations between weight and certain diseases.

Furthermore, the focus on weight loss can set patients up for a lifetime of weight cycling patterns (repeated loss and regain of weight). Weight cycling takes a toll on mental health and has been linked with increased risks of depression, low self-esteem, and eating disorders [1, 6]. It also has serious metabolic consequences and has been linked to greater risk of cardiovascular disease, hypertension, and mortality [1, 7, 8]. Thus, the emphasis on weight loss can ultimately worsen a person’s physical and emotional health.

Health-promoting behaviours impact health independently of weight loss. Stigmatizing people in larger bodies may demotivate, rather than encourage, adjustments in health behaviours and can simultaneously increase risk of disordered eating, healthcare avoidance, depression, and poor self-esteem [9, 10]. Research shows that blood pressure, blood lipids, and insulin sensitivity can all be improved without significant changes to body weight [4]. In fact, weight cycling can lead to inflammation, which contributes to hypertension, insulin resistance, and dyslipidemia [4].

Understanding Patients’ Perspectives
The desire to lose weight is common in a culture that idealizes thinness and demonizes fatness. Patients may seek weight loss advice as an expression of internalized weight stigma, shame, and the desire to escape the bias and oppression that they face in their lives. Conversations should be shifted to emphasize health promoting behaviours and address social determinants of health, while taking the focus off weight [1].

Propositions for Change
1. Shift your focus from weight to health promoting behaviours as indicators of health. Encouraging regular physical activity, balanced nutrition, stress management, smoking avoidance, and adequate sleep can improve health outcomes irrespective of weight. Work with patients to set realistic and achievable goals.
2. Avoid making assumptions about a patient’s health, diet, or exercise habits based solely on their body weight, body shape, or BMI. Be better than the 1 in 5 Canadian physicians that believe that patients with higher weight tend to have “bad behaviours” or might not be compliant with your treatment recommendations [2].
3. Ask patients permission before discussing weight, diet, and exercise.
4. Continually assess your personal weight biases. Examine your implicit associations by taking the online Implicit Association Test – Weight at www.implicit.harvard.edu
5. Don’t “diagnose” your patients based off weight. Provide your patient with the same diagnosis and treatment you would provide to a thinner patient with a similar concern. Ask yourself, “What would I recommend and prescribe for a thin patient with this concern?” Focus on treating the condition rather than the weight.

The weight-centric model of healthcare is not only ineffective but also harmful. By implementing a weight-inclusive approach, we can promote a more holistic and equitable form of healthcare that prioritizes overall well-being over arbitrary weight metrics.

The evidence is clear: focusing on health behaviours and reducing weight stigma leads to better health outcomes for all patients. It is time for the medical field to adopt these principles and create a more inclusive and supportive environment for individuals of all body types.


1. Mauldin, K., M. May, and D. Clifford, The consequences of a weight-centric approach to healthcare: A case for a paradigm shift in how clinicians address body weight. Nutrition in Clinical Practice, 2022. 37(6): p. 1291-1306.
2. Alberga, Angela S., et al., Examining Weight Bias among Practicing Canadian Family Physicians. Obesity Facts, 2019. 12(6): p. 632-638.
3. Bacon, L., Health at every size : the surprising truth about your weight. 2010: Dallas, TX : BenBella Books, [2010] ©2010.
4. Bacon, L. and L. Aphramor, Weight Science: Evaluating the Evidence for a Paradigm Shift. Nutrition Journal, 2011. 10(1): p. 9.
5. Alberga, A.S., et al., Weight bias: a call to action. Journal of Eating Disorders, 2016. 4(1): p. 34.
6. Madigan, C.D., et al., Is weight cycling associated with adverse health outcomes? A cohort study. Preventive Medicine, 2018. 108: p. 47-52.
7. Rhee, E.J., Weight Cycling and Its Cardiometabolic Impact. J Obes Metab Syndr, 2017. 26(4): p. 237-242.
8. Montani, J.-P., Y. Schutz, and A.G. Dulloo, Dieting and weight cycling as risk factors for cardiometabolic diseases: who is really at risk? Obesity Reviews, 2015. 16(S1): p. 7-18.
9. Puhl, R.M. and L.M. Lessard, Weight Stigma in Youth: Prevalence, Consequences, and Considerations for Clinical Practice. Current Obesity Reports, 2020. 9(4): p. 402-411.
10. Wu, Y.-K. and D.C. Berry, Impact of weight stigma on physiological and psychological health outcomes for overweight and obese adults: A systematic review. Journal of Advanced Nursing, 2018. 74(5): p. 1030-1042.